第七讲 下呼吸道课件.pptVIP

Acute Uncomplicated Cystitis急性膀胱炎 These infections are predominantly caused by E. coli, and antimicrobial therapy should be directed against this organism initially. Other causes include S. saprophyticus and occasionally K. pneumoniae and Proteus mirabilis.主最要病原菌为大肠杆菌，腐生葡萄球菌、克雷伯杆菌及奇异变形杆菌 Because the causative organisms and their susceptibilities are generally known, a cost-effective approach to management is recommended that includes a urinalysis and initiation of empiric therapy without a urine culture 无需尿培养，直接治疗 Short-course therapy (3-day therapy) with trimethoprim–sulfamethoxazole or a fluoroquinolone (e.g., ciprofloxacin,levofloxacin, or norfloxa-cin) is superior to single-dose therapy for uncomplicated infection and should be the treatment of choice. Amoxicillin or sulfonamides are not recommended because of the high incidence of resistant E. coli. Follow-up urine cultures are not necessary in patients who respond 。3天的SMZ-TMP联合氟喹诺酮类（环丙沙星、左氧氟沙星、诺氟沙星）比单药治疗单纯性感染更加有效。不推荐阿莫西林与磺胺类合用，因为上述细菌严重耐药，治疗效果明显的无需尿培养。 Symptomatic Abacteriuria症状性无菌尿 Single-dose or short-course therapy with trimethoprim–sulfamethoxazole has been used effectively, and prolonged courses of therapy are not necessary for the majority of patients.磺胺类单剂量短程疗法对大部分病人足够了 If single-dose or short-course therapy is ineffective, a culture should be obtained.如果无效，则需尿培养 If the patient reports recent sexual activity, therapy for Chlamydia trachomatis should be considered (azithromycin 1 g as a single dose or doxycycline 100 mg twice daily for 7 days).如果近期有性行为史，考虑进行阿奇霉素或者多四环素治疗 Asymptomatic Bacteriuria无症状细菌尿(ASB) 推荐筛查和治疗孕妇以及接受了可能导致尿道粘膜出血的侵入性操作的ASB患者。 非妊娠女性ASB，对非妊娠女性的ASB进行治疗，既不会降低感染的发生率，也不能阻止ASB的复发。因此，不推荐对绝经前非妊娠妇女的ASB进行治疗。 老年人ASB，由于老年人尿路感染的复发率和再感染率较高，对ASB者应用抗菌药物治疗并不能使复发率或病死率减低，而且ASB也不影响老年人的预期寿命，所以不推荐。 此外对于下列患者合并ASB，均不推荐进行筛查或治疗，包括患糖尿病的女性，健康的男性，有长期护理设备；留置导尿管、肾脏造瘘管或输尿管支架管；脊髓损伤和念珠菌尿的患者。此外对于接受肾移植的患者，在最初6个月内不推荐