四川大学华西医院：尿路感染（PPT讲稿）Urinary Tract Infection（UTI）Urethral Terrorist Incident?

EcO Urinary tract Infection (UTI Urethral terrorist incident? 鲍一歌 四川大学华西医院

Urinary Tract Infection (UTI) Urethral Terrorist Incident? 鲍一歌 四川大学华西医院

UTI: a quick view · Definition of ut Presence of pathogen in the urinary tract and invasion and reaction of the urinary tract to the disease producing organisms and their toxins. The reaction usually includes inflammation of the involved organ Key: Bacteria inflammation

UTI: a quick view • Definition of UTI • Presence of pathogen in the urinary tract and invasion and reaction of the urinary tract to the disease producing organisms and their toxins. The reaction usually includes inflammation of the involved organ. • Key: Bacteria + inflammation

UTl:a quick view The inflammation cause by pathogenic microorganism involving any parts of genitourinary tract These infections can spread from a given locus to any or all of the others

UTI: a quick view • The inflammation cause by pathogenic microorganism involving any parts of genitourinary tract. • These infections can spread from a given locus to any or all of the others

UTl sites Necrotizing papillitis Renal abscess R ena carbunc le Perinephric abscess Pyelonephritis nephrosis Cystitis Prostatitis Epididymitis Urethritis

UTI sites • Pyelonephritis • Cystitis Necrotizing papillitis Renal abscess Renal carbuncle Perinephric abscess Prostatitis Epididymitis Urethritis Pyonephrosis

Pathways of pathogen infect urinary tract: 1.Ascending route Most common cause 2. Hematogenous spreads kidney To kidney, prostate, testis Usually are straptococcus Ureter 3. Lymphatogenous spreads Through the lymphatic channels Bladder from the neighbor infection 4. Direct extension from another organ Urethra Intraperitoneal abcesses like Appendiceal abcess

Pathways of pathogen infect urinary tract: 1. Ascending route Most common cause 2. Hematogenous spreads To kidney, prostate, testis Usually are straptococcus 3. Lymphatogenous spreads Through the lymphatic channels from the neighbor infection 4. Direct extension from another organ Intraperitoneal abcesses like Appendiceal abcess

UTl:a quick view UTls are the most common infections just secondary to those involved respiratory system Women are especially prone to Utls, One woman in five develops a uti during her lifetime Why? UTls in men are not so common but they can be very serious when they do occur Why?

UTI: a quick view • UTIs are the most common infections just secondary to those involved respiratory system. • Women are especially prone to UTIs, One woman in five develops a UTI during her lifetime. Why? • UTIs in men are not so common, but they can be very serious when they do occur. Why?

UTI in a nutshell Typical clinical scenario Young female Dysuria, frequency Urinalysis WBC+++ Nitrite +ve Urine c&s Escherichia coli growth Resistant to all beta lactams and beta lactamase inhibitor except carbapenems RX Levofloxacin 500 mg qd po x 3d

UTI in a nutshell • Typical clinical scenario • Young female • Dysuria, frequency • Urianalysis • WBC +++ • Nitrite +ve • Urine C&S • Escherichia coli growth • Resistant to all beta lactams and beta lactamase inhibitor except carbapenems • Rx • Levofloxacin 500 mg qd po x 3d

UTI in a nutshell Typical clinical scenario Young female Dysuria, frequency Uranalysis WBC+++ RBC+ Nitrite +tive Urine c&s Escherichia coli growth Resistant to all beta lactams and beta lactamase inhibitor except carbapenems RX Levofloxacin 500 mg gd po x 3d

UTI in a nutshell • Typical clinical scenario • Young female • Dysuria, frequency • Urianalysis • WBC +++ • RBC + • Nitrite +tive • Urine C&S • Escherichia coli growth • Resistant to all beta lactams and beta lactamase inhibitor except carbapenems • Rx • Levofloxacin 500 mg qd po x 3d

1. Female UTl: more common and more recurrence Short urethra Shorter route for bacteria to enter the bladder Antimicrobial effect of urine Close to vagina anus Reservoirs Men are less common in utl, but more likely to have recurrence after the 1t episode why?

1. Female UTI: more common and more recurrence • Short urethra • Shorter route for bacteria to enter the bladder • Antimicrobial effect of urine • Close to vagina & anus • Reservoirs • Men are less common in UTI, but more likely to have recurrence after the 1st episode. Why?

UTI in other population more complicated Pregnancy: asymptomatic bacteriuria(5%). Risk of pyelonephritis and miscarriage Screen at 1s trimester Senior male: asymptomatic bacteriuria intertwisted with bph Pediatric: more likely to become pyelonephritis, screen for congenital abnormalities vur etc)

UTI in other population: more complicated • Pregnancy: asymptomatic bacteriuria (5%). Risk of pyelonephritis and miscarriage. Screen at 1st trimester • Senior male: asymptomatic bacteriuria, intertwisted with BPH • Pediatric: more likely to become pyelonephritis, screen for congenital abnormalities (VUR etc)