urinary tract infections.pptVIP

Urinary Tract Infections (UTIs)尿 路 感 染 张 莹 The second Affiliated Hospital of Guangzhou Medical College UTIs Definition Etiology and Pathogenesis Clinical presentation Testing Diagnosis Treatment Case Ms Wang, female, 40 years old. Main complains :Urine frequency and urgency for 3 days. What is your preliminary diagnosis? What test will you take? What is your next treatment? UTIs Definition Etiology and Pathogenesis Clinical presentation Testing Diagnosis Treatment acute or chronic inflammatory reactions caused by proliferation of pathogenic microorganisms existing in the urinary tract. UTIs Classifications Upper(kidney) and lower(bladder and urethra) UTIs Acute and chronic UTIs Complicated（复杂性） and uncomplicated（非复杂性） UTIs Recurrence of UTIs（复发性） : relapse（复发） or reinfection（再感染） Asymptomatic bacteriuria（无症状性细菌尿） UTIs Definition Etiology and Pathogenesis Clinical presentation Testing Diagnosis Treatment Etiology Many different microorganisms can infect the uriary tract .The most common agents are the gram-negative bacilli. Etiology Other gram-negative rods, especially Proteus(变形杆菌 ) and Klebsiella(克雷伯杆菌) account for a smaller proportion of uncomplicated infection Gram-positive cocci play a lesser role in UTIs Others: Virus (病毒), Fungi (真菌), Chlamydia(衣原体), Mycoplasma(支原体） UTIs Definition Etiology and Pathogenesis Clinical presentation Testing Diagnosis Treatment Pathogenesis routes of infection (1) Ascending route: urethra bladder kidneys, nearly 95% of UTIs (2) Hematogenous route: bacteremia kidney (3) Direct route (4) Lymphatic route :bacteria lymphatic vessel kidney Pathogenesis  Defense mechanisms 1. Elimination of bacteria by voiding 2. Antibacterial properties of urine and the bladder mucosa 3. A high urea concentration, high osmolarity and low pH 4. Prostatic（前列腺） secretions (male) 5. Polymorphonuclear leukocytes enter the bladder epithelium（上皮细