泌尿系统感染Urinary_tract_infection(1)PPT课件2.ppt

Antimicrobial Therapy Empiric Therapy - based on most probable pathogens - local rates of resistance - acute infection vs chronic - reinfection or relapse - indwelling catheter etc * Management of UTI Anatomical/Functional Predisposition to UTI Impaired bladder emptying Dysfunction Neuropathy VUR BOO Diverticulum * THANK YOU SUCCESS * 百度文库你丫的 * Management of UTI Anatomical/Functional Predisposition to UTI Obstruction Any level VUR Calculi very difficult to eradicate if UTI and stones * Management of UTI Anatomical/Functional Predisposition to UTI Intrarenal Renal scars Interstitial nephritis Papillary necrosis Medullary sponge kidney APKD Congenital calyceal obstruction * Management of UTI Anatomical/Functional Predisposition to UTI Associated conditions Diabetes mellitus Pregnancy Immunosuppression Elderly * Management of Female UTI Bacterial Factors Adherence Adhesins Fimbriae Non-fimbrial Adhesins Biofilms Important in catheter UTI Soluble Virulence Factor Production Disrupt bladder protective mucus layer * Management of Female UTI Bacterial Factors Iron Acquisition Mechanisms Siderophores and Haemolysins Allow growth Serogroup and Serum R O ag LPS outer G -ve Prevent complement destruction Capsules K ag covers bacteria capsule Protects v phagocytosis and complement attack * Management of Female UTI Bacterial Factors Ig Proteases Cleave gut IgA Ureteric Paralysis P. Fimbriae and endotoxin Motility Ascent of LUT Urease Production Hydrolyse urea and increases ammonia which increases bacterial adherence * Management of Female UTI Host Factors Colonisation of vagina, introitus, urethra Biological predisposition Hormone deficiency vaginal atrophy Spermicidal jelly increases vaginal pH Antibiotics reduce vaginal lactobacilli and increase pH Ascent to bladder Sexual milkback Catheterisation * Management of Female UTI Host Factors Establishment of bacteria in bladder Urine composition (extremes inhibit bacterial growth) Reduced IgA and IgG Red