Urinary tract infection.ppt
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1、n7 million office visits yearlyn1 million hospitalizationsnAbout 2/3rds of patients are women;40%to 50%of women have UTI at some point during their livesnImportant complications of pregnancy,diabetes mellitus,polycystic disease,renal transplantation,conditions that impede urine flow(structural and n
2、eurologic)nUrinary tract infectionnSignificant bacteriurianAsymptomatic bacteriurianAcute pyelonephritisnChronic pyelonephritisn“Upper”versus“lower”UTInUrethral syndromenUTI:the finding of microorganisms in bladder urine with or without clinical symptoms and with or without renal diseasenSignificant
3、 bacteriuria:the finding of 105 cfu/ml of urine(but lower counts can be significant)nAsymptomatic bacteriuria:Significant bacteriuria without clinical symptoms or other abnormal findings.nAcute bacterial pyelonephritis:a clinical syndrome of fever,flank pain,and tenderness,often with constitutional
4、symptoms,leukocyte casts in the urine,and bacteriuria;or histologic findings thereofnChronic bacterial pyelonephritis:Long-standing infection associated with active bacterial growth in the kidney;or the residuum of lesions caused by such infection in the pastnChronic interstitial nephritis:renal dis
5、ease with histologic findings resembling chronic bacterial pyelonephritis but without evidence of infectionn“Upper UTI”:infection above the level of the bladdern“Lower UTI”:infection at or below the level of the bladdern“Urethral syndrome”:clinical manifestations of lower UTI(dysuria,frequency,urgen
6、cy)without significant bacteriurianPyuria:the presence of pus(WBCs leukocytes in urine,which may or may not be caused by UTI.The preferred method for quantitation is enumeration in unspun urine using a counting chamber.The leukocyte esterase nitrite test has a sensitivity of between 70%and 90%for sy
7、mptomatic UTInIn patients with asymptomatic bacteriuria without infection,a colony count of 105 cfu/ml defines infectionnScreening has little apparent value in adults except during pregnancy and prior to urologic surgerynUp to 40%of elderly men and women have asymptomatic bacteriuria nAfter one blad
8、der catheterization:2%nMedical outpatients:5%nPregnancy at term:10%nHypertensive patients:14%nDiabetes mellitus:20%nWomen with cystocoele:23%nCongenital urologic disease:57%nHydronephrosis;nephrolithiasis:85%nIndwelling catheter,open drainage 48 hours:98%(reference:Jackson et al,Arch Intern Med 1962
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