(精选)UTI教学课件.pptVIP

UTI 梅健泰 Ref.: Management of Urological Emergencies, 2004, Taylor Francies UTI - DEFINITIONS Bacteriuria :the presence of bacteria in the urine from upper and lower urinary tract sources with the presence or absence of both pyuria and symptoms. Urinary tract infection (UTI) : occurs when a microbial agent, usually bacterial, invades and colonizes the urinary tract. Uncomplicated UTIs (simple UTIs) : in a structurally and functionally normal urinary tract, when the patient is not pregnant, and when there is no history of recent antimicrobial use. eg. most isolated or recurrent lower UTIs and acute pyelonephritis in female patients. Uncomplicated pyelonephritis, as an example, accounts for approximately 25% of all UTI-related admissions for inpatient treatment. Complicated UTIs : in a structurally and/or functionally abnormal urinary tract. eg. secondary to urinary tract catheterization, urolithiasis, obstructive uropathy, instrumentation, diabetes mellitus, pregnancy, immunosuppression and congenital or secondary variations of urinary tract anatomy such as prune belly syndrome, ileal conduits and bladder augmentation UTI - INCIDENCE Female : Male = ~30:1 Young children : M F ( up to approximately 6 months of age). In female : the incidence of UTIs increases with advancing age. Approximately 1% of girls 5-15 years of age (bacteriuria). 5% in early adulthood (bacteriuria). Up to 30% between 20 and 40 years :experience an acute bacterial UTI requiring treatment. Approximately 20% of women and 10% of men over 70 years of age will have bacteriuria upon culture of their urine. UTI - PATHOGENESIS Ascending route : most commonly, bacteria enter the bladder via the urethra. Large bowel commensal organisms colonizing the perineum, the perianal region the prepuce in the male Hematogenous and lymphatic pathways : far less common, the spread of bacteria from adjacent organs. RISK FACTORS FOR URINARY TRACT INFECTION Host factors urinary stasis, local trauma, abnorm