tract infection尿路感染课件.pptVIP

Urinary Tract Infection尿路感染 Nephrology Department Xuan Wu Hospital The Capital University of Medical Sciences Outline提纲 Definition Epidemiology Classification Microbiology Pathogenesis Presentations Acute cystitis Acute pyelonephritis Chronic pyelonephritis Complications Diagnosis Differentiation Recurrent infection Asymptomatic bacteriuria Urethral syndrome Therapy Definition定义 Urinary tract infection is a general term indicating the invasion of microorganisms into a previously sterile urinary system. Urinary tract尿路 Intravenous pyelography静脉肾盂造影 Epidemiology流行病学 Be seen most frequently in women. -Symptomatic infection: childbearing years, 18 to 40 years. Approximately 10%~20% of women experience symptomatic urinary tract infections during their lifetime. -Asymptomatic bacteriuria: elderly women. Infections in males most frequently occur after 40 years associated with prostatic obstruction or calculi. Classification分类 Type of microorganism: bacterial, fungal, viral Site of infection: lower, upper urinary tract Presence or absence of symptoms Acute or chronic infection Presence or absence of complicating diseases or urinary tract abnormalities First or persistent infection Microbiology微生物学 Escherichia coli 大肠埃希杆菌(90%) Klebsiella 克雷伯杆菌 Enterobacter 肠菌属 Pseudomonas 假单胞菌属 Proteus 变形杆菌属 Staphylococcus 葡萄球菌 Enterococcus 肠球菌 Chlamydia trachomatis 沙眼衣原体 Pathogenesis 发病机理 The routs of bacteria to the kidney -Ascending infection: principal pathway urethra, bladder, ureter, pelvis, parenchyma -Hematogenous spread -Lymphogenous spread Pathogenesis发病机理 Local host defense -Length of male urethra -Prostatic antibacterial factor -Normal vaginal flora 菌群 -Cervicovaginal antibody production -Voiding 排空 mechanism -Bladder surface glycosaminoglycan 葡糖胺 -Competent vesicoureteral 膀胱输尿管 valves -Urinary acidification, concentration, ammoniagenesis -Tamm-Horsfall mucoprotein Pathogenesis发病机理 Organism virulence factors -Pili attachm