泌尿生殖道感染

泌尿生殖道感染泌尿生殖道感染第1页

Urinarytractinfections(UTIs)causedbypathogenicbacteria

caninvolveanyofthegenitalorurinaryorgansandeventually

canspreadfromonesitetoany

oralloftheothers.

泌尿生殖道感染第2页Definitions1

Urinarytractinfectionisaninflammatoryresponseoftheurotheliumtobacterialinvasionthatisusuallyassociatedwithbacteriuriaandpyuria.泌尿生殖道感染第3页MostUTIsarecausedbyaerobicgram-negativerods,(Escherichiacoli.),gram-positivecocci(enterococci)andtoalesserextentbyanaerobicbacteria.

Definitions2

泌尿生殖道感染第4页Definitions3Bacteriuriaisthepresenceofbacteriaintheurine,whichisnormallyfreeofbacteria,andimpliesthatthesebacteriaarefromtheurinarytractandarenotcontaminantsfromtheskin,vagina,orprepuce.泌尿生殖道感染第5页Definitions4Pyuria

isthepresenceofwhiteblood

cellsintheurineBacteriuriawithoutpyuriaindicates

bacterialcolonizationratherthan

infection.Pyuriawithoutbacteriuriawarrants

evaluationfortuberculosis,stone,orcancer.泌尿生殖道感染第6页Classification泌尿生殖道感染第7页Accordingtotheirnaturehistory

Firstinfections/IsolatedInfection

Recurrentinfections

Bacterialpersistence

Reinfections

泌尿生殖道感染第8页Reinfection

isrecurrentinfectionwithdifferentbacteriafromoutsidetheurinarytract.Eachinfectionisanewevent;theurinemustshownogrowth

aftertheprecedinginfection.泌尿生殖道感染第9页Bacterial

persistencereferstoarecurrenturinarytractinfectioncausedbythesamebacteriafromafocuswithintheurinarytract,suchasaninfectionstoneortheprostate.泌尿生殖道感染第10页

AccordingtoTheirSiteofOrigin

Upperurinarytractinfection

Lowerurinarytractinfection

Genitalsysteminfection

泌尿生殖道感染第11页泌尿生殖道感染第12页Upper-tractinfectionAcutepyelonephritisChronicpyelonephritisEmphysematouspyelonephritisRenalabscessPerinephricabscessXanthogranulomatouspyelonephritis泌尿生殖道感染第13页 Lower-tractinfectionAcuteurethralsyndrome(Women)Acutecystitis泌尿生殖道感染第14页

GenitalinfectionAcuteandchronicbacterialprostatitis.Acuteandchronicepididymitis.泌尿生殖道感染第15页PathogenesisBacterialpathogenesisintheurinarytractdependsonanumberoffacters,chiefofwhicharetheBacterial

VirulenceFactersandtheHostSusceptibilityFactor泌尿生殖道感染第16页

Bacterialvirulencefactors

AbilityofadherencetourothelialcellsAbilitytoresistbactericidalactivityAbilitytoproducehemolysin.泌尿生殖道感染第17页

HostsusceptibilityfactorsEmptyingofurineSurfacemucinsUrinaryantibodiesUrinaryosmolalitypH泌尿生殖道感染第18页Routesofinfection(1)Ascendinginfection(2)Hematogenousspread(3)Lymphatogenousspread(4)Directextension

泌尿生殖道感染第19页泌尿生殖道感染第20页泌尿生殖道感染第21页泌尿生殖道感染第22页DIAGNOSIS泌尿生殖道感染第23页UrineCollectionSuprapubicAspirationUrethralCatheterizationSegmentVoidedUrineSpecimens泌尿生殖道感染第24页泌尿生殖道感染第25页Urinlysis

Morethan3freshleukocytes/High-powerfield泌尿生殖道感染第26页Quantitativeurineculture

Coloniesformingunitspermilliliter(cfu/ml)100,000cfu/ml1000to10,000cfu/ml泌尿生殖道感染第27页Locationofurinarytractnfection.SymptomsandsignsLaboratoryfindingsX-RayfindingsRadionuclideimagingMRIfindings泌尿生殖道感染第28页Treatmentstrategy.Antimicrobialdrug

Mdicationforpain,fever,andnausea.

Togivefluidsintravenouslyandorally

Complicatingfactors(eg.Obstructiveurographyorinfectedstones)泌尿生殖道感染第29页

AcutePyelonephritis泌尿生殖道感染第30页DefinitionsAcutepyelonephritisisdefinedasinflammationoftheparenchymaandthepelvisofthekidneycausingbybacterialinfection.泌尿生殖道感染第31页Etiology&PathogenesisAerobicgram-negativebacteriaEcoli

Gram-negativeentricorganisms

Enterococci,andstaphylococcusaureusAscendinginfection(VUR)Hematogenous泌尿生殖道感染第32页Clinicalfindings1Anabruptonsetofchill,moderatetohighfeverDysuria,frenquency,urgency.Abdominalpain,nausea,vomiting,andevendiarrhea.

泌尿生殖道感染第33页Clinicalfindings2CostovertebralangletendernessPalpationorpercussionoverthecostovertebralangleontheaffectedkidneyusuallycausespain.Thepatientsometimeshasabdominaldistention,tenderness,andaquietintestine泌尿生殖道感染第34页Dignosis1Laboratoryfindings:LeukocytosisPyuria,Bacteriuria,Proteinuria,HematuriaQuantitativeurinecultureTotalrenalfunction泌尿生殖道感染第35页

Dignosis2

Imaging:PlainfilmExcretoryurograms.VoidingcystogramCTUltrasonographyRadionuclide泌尿生殖道感染第36页DifferentialDiagnosisPancreatitisBasalpneumoniaAcute-intra-abdominaldiseaseWomenpelvicinflammatorydiseaseandacuteprostatitisRenalabscessPerinephricabcess.泌尿生殖道感染第37页

Treatment1Antimicrobialdrugs:TheappropriateintravenoustreatmentOraldrugRepeaturinecultures泌尿生殖道感染第38页

Treatment2Specificmeasures:Anycomplicatingfactors(eg.obstructiveurography)泌尿生殖道感染第39页

Prostatitis泌尿生殖道感染第40页TypesofprotatitisDrach(1978)(1)acuteandchronicbacterialprostatitis,(2)nonbacterialprostatitis(3)prostatodynia.泌尿生殖道感染第41页NIDDKcategorizationandDrachclassificationNIDDKClassification(1995)Drachclassification(1978)Category1AcutebacterialprostatitisAcutebacterialprostatitisCategory2ChronicbacterialprostatitisChronicbacterialprostatitisCategory3Chronicpelvicpainsyndrom3aInflammatorytypeNonbacterialprostatitis

3bNoninflammatorytype

ProstatodyniaCategory4Asymptomaticinflammatoryprostatitis泌尿生殖道感染第42页DiagnostictechniquesTheexpressedprostaticsecretions(EPS)Leukocytes<10perhigh-powerfield(hpf)

泌尿生殖道感染第43页泌尿生殖道感染第44页泌尿生殖道感染第45页泌尿生殖道感染第46页The4-glasstest(Stamey1968)UrethritisCystitisprostatitisVB1++/--/+VB2-+-EPS--/++(10timesthanVB1)VB3--/++泌尿生殖道感染第47页泌尿生殖道感染第48页泌尿生殖道感染第49页Acutebacterialprostatitis泌尿生殖道感染第50页Etiology&Pathogenesis

Ecoli80%

Enterococci5-10%AnaerobesrarelyIntraprostaticrefluxofurineInvasionbyrectalbacteriaHematogenousspread

泌尿生殖道感染第51页Clinicalfeatures

Thesuddenonsetoffever,chills.Lowbackandperinealpain.Frenquencyandurgency,nocturia,dysuriaVaryingdegreesofbladderoutletobstruction.泌尿生殖道感染第52页Digitalrectalexamination(DRE)Tender,swollenprostategland,irregularlyfirmandwarmUrinemaybecloudyandmalodorous,andgrosshematuriaisobserved泌尿生殖道感染第53页Diagnosis

Acompletebloodcountshowsleukocytosiswithashifttowardimmatureforms.Thevoidedurineshowspyuria,microscopichematuria,andbacteria.CultureofvoidedurinesampleusuallyidentifiesthepathogensUltrasonography泌尿生殖道感染第54页TreatmentAntibiotictreatmentfor4-6weeksSupportivemeasuresincludeantipyretics,analgesics,stoolsorfteners,hydration,andbedrest.Anytransurethralcatheterizationorinstrumentationiscontraindicated.Acuteurinaryretentionshouldbemanagedwithsuprapubicdrainage

泌尿生殖道感染第55页Chronicbacterialprostatitis泌尿生殖道感染第56页Etiology&PathogenesisThegram-nagativeorganismsThegram-positiveorganismsMycoplasmal,chlamydialspeciesIntraprostaticrefluxofurinepHofprostaticsecretionsZinc泌尿生殖道感染第57页Clinicalfindings1Irritativevoidingdysfunction(dysuriaurgency,frequency,nocturia)LowbackorperinealpainSexualdysfunctionMyalgiaandarthralgiaOthersymptoms泌尿生殖道感染第58页Clinicalfindings2DRE:normal,tenderness,swelling,firmnessSecondaryepididymitisHematouria,hematospermia,urethraldischarge泌尿生殖道感染第59页DiagnosisThe4-glasstestTheexpressedprostaticsecretions(EPS)Leukocytes<10perhigh-powerfield(hpf)Sonography泌尿生殖道感染第60页判别诊疗II型和III型应与可能造成骨盆区域疼痛和排尿异常疾病进行判别诊疗间质性膀胱炎、睾丸附睾和精索疾病、肛门直肠疾病、腰椎疾病BPH、膀胱过分活动症、神经原性膀胱膀胱肿瘤、前列腺癌泌尿生殖道感染第61页治疗标准慢性前列腺炎无明确进展性，不足以威胁患者生命和主要器官功效，并非全部前列腺炎均需治疗。慢性前列腺炎治疗目标主要是缓解疼痛、改进排尿症状和提升生活质量，疗效评价应以症状改进为主。前列腺炎应采取综合治疗。泌尿生殖道感染第62页治疗方法

一、Ⅰ型一旦临床诊疗或得到血、尿培养结果后，应马上应用抗生素。开始时可经静脉应用抗生素，如：广谱青霉素、三代头孢菌素、氨基糖甙类或氟喹诺酮等。待患者发烧等症状改进后，改用口服药品（如氟喹诺酮等），疗程最少4周。并发症处理：伴尿潴留者——细管导尿或膀胱穿刺造瘘。伴脓肿形成者——可采取穿刺引流、经尿道切开引流泌尿生殖道感染第63页治疗方法二、Ⅱ型和Ⅲ型（一）普通治疗：

健康教育、心理和行为辅导有主动作用。慢性前列腺炎患者应戒酒，忌辛辣刺激食物；防止憋尿、久坐，注意保暖，加强体育锻炼。热水坐浴有利于缓解疼痛症状。泌尿生殖道感染第64页治疗方法

二、Ⅱ型和Ⅲ型（二）药品治疗

1．抗生素

2．α-受体阻滞剂

3．非甾体抗炎镇痛药

4．植物制剂

5．M-受体阻滞剂

6．抗抑郁药及抗焦虑药

7．中医中药泌尿生殖道感染第65页治疗方法

抗生素

Ⅱ型：依据细菌培养结果和药品穿透前列腺能力选择抗生素。药品穿透前列腺能力取决于其离子化程度、脂溶性、蛋白结合率、相对分子质量及分子结构等。常见抗生素是氟喹诺酮类药品（如环丙沙星、左氧氟沙星和洛美沙星等）、四环素类（如米诺环素等）和磺胺类（如复方新诺明）。前列腺炎确诊后，抗生素治疗疗程为4~6周，泌尿生殖道感染第66页治疗方法

ⅢA型：抗生素治疗大多为经验性治疗。推荐先口服氟喹诺酮或四环素等类抗生素2~4周，然后依据其疗效反馈决定是否继续