泌尿生殖道感染.ppt
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1、Infection of the Genitourinary Tract,Hongshu MaDepartment of UrologyTianjin First Central Hospital,Urinary tract infections(UTIs)caused by pathogenic bacteria can involve any of the genital or urinary organs and eventually can spread from one site to anyor all of the others.,Definitions 1,Urinary tr
2、act infection is an inflammatory response of the urothelium to bacterial invasion that is usually associated with bacteriuria and pyuria.,Most UTIs are caused by aerobic gram-negative rods,(Escherichia coli.),gram-positive cocci(enterococci)and to a lesser extent by anaerobic bacteria.,Definitions 2
3、,Definitions 3,Bacteriuria is the presence of bacteria in the urine,which is normally free of bacteria,and implies that these bacteria are from the urinary tract and are not contaminants from the skin,vagina,or prepuce.,Definitions 4,Pyuria is the presence of white blood cells in the urine Bacteriur
4、ia without pyuria indicates bacterial colonization rather than infection.Pyuria without bacteriuria warrants evaluation for tuberculosis,stone,or cancer.,Classification,According to their nature history First infections/Isolated InfectionRecurrent infections Bacterial persistence Reinfections,Reinfe
5、ction is recurrent infection with different bacteria from outside the urinary tract.Each infection is a new event;the urine must show no growth after the preceding infection.,Bacterial persistence refers to a recurrent urinary tract infection caused by the same bacteria from a focus within the urina
6、ry tract,such as an infection stone or the prostate.,According to Their Site of Origin,Upper urinary tract infection Lower urinary tract infectionGenital system infection,Upper-tract infection,Acute pyelonephritisChronic pyelonephritisEmphysematous pyelonephritisRenal abscess Perinephric abscessXant
7、hogranulomatous pyelonephritis,Lower-tract infection,Acute urethral syndrome(Women)Acute cystitis,Genital infection,Acute and chronic bacterial prostatitis.Acute and chronic epididymitis.,Pathogenesis,Bacterial pathogenesis in the urinary tract depends on a number of facters,chief of which are the B
8、acterial Virulence Facters and the Host Susceptibility Factor,Bacterial virulence factors,Ability of adherence to urothelial cells Ability to resist bactericidal activity Ability to produce hemolysin.,Host susceptibility factors,Emptying of urineSurface mucins Urinary antibodiesUrinary osmolalitypH,
9、Routes of infection,(1)Ascending infection(2)Hematogenous spread(3)Lymphatogenous spread(4)Direct extension,DIAGNOSIS,Urine Collection,Suprapubic AspirationUrethral CatheterizationSegment Voided Urine Specimens,Urinlysis,More than 3 fresh leukocytes/High-power field,Quantitative urine culture,Coloni
10、es forming units per milliliter(cfu/ml)100,000 cfu/ml 1000 to 10,000 cfu/ml,Location of urinary tract nfection.,Symptoms and signsLaboratory findingsX-Ray findingsRadionuclide imagingMRI findings,Treatment strategy.,Antimicrobial drug Mdication for pain,fever,and nausea.To give fluids intravenously
11、and orally Complicating factors(eg.Obstructive urography or infected stones),Acute Pyelonephritis,Definitions,Acute pyelonephritis is defined as inflammation of the parenchyma and the pelvis of the kidney causing by bacterial infection.,Etiology&Pathogenesis,Aerobic gram-negative bacteria E coli Gra
12、m-negative entric organisms Enterococci,and staphylococcus aureusAscending infection(VUR)Hematogenous,Clinical findings 1,An abrupt onset of chill,moderate to high fever Dysuria,frenquency,urgency.Abdominal pain,nausea,vomiting,and even diarrhea.,Clinical findings 2,Costovertebral angle tendernessPa
13、lpation or percussion over the costovertebral angle on the affected kidney usually causes pain.The patient sometimes has abdominal distention,tenderness,and a quiet intestine,Dignosis 1,Laboratory findings:Leukocytosis Pyuria,Bacteriuria,Proteinuria,HematuriaQuantitative urine culture Total renal fu
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