上泌尿道感染的主因可能是血原性.ppt

泌尿道保健--關於泌尿道感染 慈濟醫院泌尿科 陳景亮 腎臟 輸尿管 膀胱 泌尿道 泌尿道感染 最常見於：生育年齡的女性，懷孕婦女、男士前列腺增大、上廁所的習慣差劣、患有糖尿病或患有鐮刀型紅血球疾病的人士罹患泌尿道感染的風險也較高。 嬰兒、小孩（小於六歲）和小於50歲男性極少出現泌尿道感染，如有則通常和泌尿道結構畸型（膀胱逆流、尿路阻塞）有關。 下泌尿道感染（lower urinary tract infections）和膀胱炎的主因通常是細菌通過尿道進入，但上泌尿道感染（upper urinary tract infections）如腎盂腎炎則不然。上泌尿道感染的主因可能是血原性（hematogenous）的。 Definitions (定義) Bacteriuria(菌尿症)- bacteria in urine Pyuria(膿尿症)- WBCs in urine Uncomplicated- healthy patient with a structurally and functionally normal urinary tract. Complicated- obstruction, anatomic or functional disorder, calculi, instrumentation, incontinence, pregnancy. Unresolved bacteriuria- resistence, multiple organisms, rapid reinfection, azotemia, papillary necrosis, infected stones or foreign body, patient noncompliance Recurrent infection- persistence or reinfection Pathogenesis(1) Ascending infection - most common Hematogenous spread - immunocompromised and neonates - uncommon except Staphylococcus, Candida and TB Lymphatogenous spread - little evidence, iatrogenic? Direct extension - intraperitoneal abscess, vesicointestinal or V-V fistula Pathogenesis(2) Host factor - Anatomic or functional abnormalities - Secretion of IL-8 from renal cells may participate in the initiation and maintenance of renal inflammation. - Increase adherence due to more receptors - Change of pH or estrogen levels, Zn Bacterial factors - Uropathogenic E.coli(O,K,H) have pili(type1, P) and hemolysin, resistant to serum bactericidal activity Pathogenesis(3) Causative pathogens - aerobic ? Escherichia coli(80%), Proteus mirabilis, Klebsiella ? Staphylococci, Pseudomonas(nosocomial) - anaerobic bacteria (suppurative infections) ? Bacteroides fragilis, Clostridium perfringens… Diabetes more likely caused by Klebsiella, group B streptococci… S. saprophyticus causing approximately 10% of symptomatic lower UTIs in young, sexually active females 膀胱感染的症狀 尿急（urinary urge