尿路感12187.ppt

尿路感染 Urinary Tract Infection  上海第二医科大学附属瑞金医院 肾脏科 Urinary Tract Infection (UTI) UTI occurs in all populations, from the neonate to the geriatric patient, but it has a particular impact on : females of all ages (especially during pregnancy) males at the two extremes of life kidney transplant patients anyone with functional or structural abnormalities of the urinary tract Urinary Tract Infection (UTI) upper UTI－pyelonephritis lower UTI －cystitis Pyelonephritis DEFINITION BACTERIOLOGY PATHOGENESIS PATHOLOGY CLINICAL PRESENTATIONS DIAGNOSTIC EVALUATION TREATMENT DEFINITION Pyelonephritis means inflammation of the kidney and its pelvis, but from a historical point of view and through common usage, the term has come to designate a disorder of the kidney resulting from bacterial invasion. Pyelonephritis DEFINITION BACTERIOLOGY PATHOGENESIS PATHOLOGY CLINICAL PRESENTATIONS DIAGNOSTIC EVALUATION TREATMENT Bacteriologic Findings Among 250 Outpatients and 150 Inpatients with UTI Bacterial Species Outpatients (%) Inpatients (%) Escherichia coli 89.2 52.7 Proteus mirabilis 3.2 12.7 Klebsiella pneumoniae 2.4 9.3 Enterococci 2.0 7.3 Enterobacter aerogenes 0.8 4.0 Pseudomonas aeruginosa 0.4 6.0 Proteus species 0.4 3.3 Serratia marcescens 0.0 3.3 Staphylococcus epidermidis 1.6 0.7 Staphylococcus aureus 0.0 0.7 Fungal Pathogens The most common form of fungal infection of the urinary tract is caused by Candida species. Most such infection occurs in patients : with indwelling Foley catheters receivin