Urinarytractinfection尿路感染.pptVIP

Urinary tract infection尿路感染 方 炜 Renal Division, Renji Hospital Shanghai Second Medical University Introduction Urinary tract infection (UTI) is the most common of all bacterial infections, affecting humans throughout their life span. Not only is UTI common, but the range of clinical effects it can produce is exceptionally broad, from acute pyelonephritis with gram-negtive sepsis to asymtomatic bacteriuria. Introduction UTI upper pelvic 肾盂 calyx 肾盏 ureter 输尿管 lower bladder 膀胱 urethra 尿道 pyelonephritis cystitis urethritis Female:male 10:1 Definition UTI: a broad term that encompasses both asymptomatic microbial colonization of the urine and symptomatic infection with microbial invasion and inflammation of urinary tract structures. Acute pyelonephritis (急性肾盂肾炎): a pyogenic, focal infection of the renal parenchyma accompanied by local and systemic symptoms of infection. Chronic pyelonephritis（慢性肾盂肾炎）: the pathologic and radiologic findings of chronic cortical scarrings, tubulointerstitial damage, and deformity of the underlying calyx. Pathogen Gram-negtive enterobacteria is most common 95% E.coli大肠杆菌 60-80% Proteus mirabilis 变形杆菌 Klebsiella sp克雷伯杆菌 Pseudomonas sp 绿脓杆菌 (urinary tract instrumentation) Serratia sp 沙雷杆菌 Gram-positive organisms 5-10% Streptococcus faecalis 粪链球菌 Staphylococcus aureus 金黄色葡萄球菌 Staphylococcus albus 白色葡萄球菌 Fungi 真菌 Yeasts 原虫 Viruses 病毒 Possible routes of infection Ascending infection Most UTI are believed to occur by the ascending route. urethra→bladder→ureter→pelvis→calyx →parenchyma Hematogenous infection Relatively rare Staphylococcal bacteremia 金葡菌血症 Intestine to kidney by way of lymphatics 盆腔器官炎症 阑尾炎 结肠炎 Direct infection 外伤 肾周器官感染 The defence mechanism of urinary tract Valve at the junction of ureter and bladder. The dilution and removal