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Knowledge of urinary tract infection
Over
Urinary tract infection (urinary tract infection, UTI) refers to a variety of pathogens cause urinary tract infections. UTI mainly bacterial pathogens, but also for fungi, viruses, mycoplasma, and parasites. UTI is a clinical common disease, can occur in all populations, more common in women, especially women of childbearing age. About 20% to 30% of women in their lifetime who have had UTI, less incidence of men, including infants, the elderly, renal transplant patients, with abnormal structure or function of the urethra to the disease. Beijing Guang An Men Hospital of Traditional Chinese Medicine nephropathy accounts for Yong Li
First, the classification of urinary tract infection
(A) of the upper urinary tract infection and lower urinary tract infection
Mainly refers to the upper urinary tract infection pyelonephritis, renal abscess renal abscess; mainly refers to the lower urinary tract infection, cystitis, urethritis and prostatitis.
(B) the complexity of the infection and non-complicated infections
Distinguish between them in the urinary tract infection diagnosis and treatment is important because both the treatment and prognosis are clearly different. Complexity of the infection is under the following circumstances arise urinary tract infection: There urinary tract structural abnormalities (such as obstruction, polycystic kidney, stones, retaining catheter, etc.); existence of urinary tract dysfuncti


on (such as spinal cord injuries, diabetes or multiple hardening caused by neurogenic bladder); renal parenchymal damage; cause systemic disease in patients with low immunity (such as diabetes, AIDS, etc.).
(C) of the initial infections and recurrent infections
Is the first time in early infections occurred UTI; recurrence of the infection that at least the past 6 months or 1 2 3 times at least during the acute non-complicated urinary tract infections.
(D) of asymptomatic bacteriuria
Refers to patients without clinical symptoms of urinary tract infection, but different than 2 times the number of clean urine culture of bacteria were 105/ml, and for the same species.
(E) Acute urethral syndrome
That there are frequent urination, urgency, dysuria, but no true bacteriuria, 70% of urinary tract infections, often accompanied by pyuria, mostly for Chlamydia trachomatis, fungi, tuberculosis and other infections caused by; the remaining 30% had no clear pathogenic microorganisms, often not accompanied by pyuria, which may be related to local stimulation.
Second, the epidemiological features
UTI incidence rate of the total population of 1% to 2%, mainly female, male to female ratio was 1:1 Pathogenesis
First, the pathogen
The most common pathogens are enteric gram-negative bacilli. Among the most common E. coli, accounting for more than 70% of urinary tract infection, followed by a Proteus, Klebsiella, Aerobacter aerogenes, Serratia spp, Alcaligenes, Streptococcus faecalis, Pseudomonas aeruginosa ( Pseudomonas aeruginosa) and Staphylococcus aureus.
Second, urinary tract infection pathway
(A) ascending infection
Ascending infection of urinary tract infection is usually caused by a bacterium upstream along the urethra to the bladder, ureter and even kidney infection. Healthy bacteria sojourn around the urethra, the bacteria from fecal contamination. Female urethra is shorter due to rapid voiding of urine after the terminal is around the urethra bacterial contamination, contaminated after the end of the urine in the bladder contraction, and being sucked back into the bladder; intercourse female urethra can be squeezed around the bacteria into the bladder; incontinence state, between the bladder and urethra there is a continuous fluid, bacteria, more up to the bladder; iatrogenic retrograde operations directly to the bacteria into the bladder.
The incidence of pyelonephritis is a bacterial infection of the urine from the bladder and then up to the renal pelvis due to retrograde. The mechanism may be related with ureteral reflux. However, the situation even without reflux, bladder and kidney is connected between the urine can also be due to bacteria attached to cilia and the urinary tract mucosa, and uplink to the kidneys.
(B) of the blood infection
Rare. Parts of the body of the infection focus, such as tonsillitis, skin boils, carbuncle, etc., otitis media, dental caries lesions and other infectious bacteria can spdirectly from the blood to the urinary and reproductive system organs, common infection in renal cortex. Mostly Staphylococcus aureus bacteria. Most occurred in the pre-existing severe urinary tract obstruction or poor immunity are.
(C) of the lymphatic infection
Bladder, ureter and kidney lymphatics are interlinked, ascending colon and right kidney similarities between the lymphatic vessels, bacteria from the lesions of adjacent organs by lymphatic spto the urinary and reproductive system organs, such as a serious intestinal infection or retroperitoneal abscess, is a more rare form of routes of infection.
(D) direct spof infection
As a direct spof infection due to adjacent organs such as appendix abscess, suppurative pelvic inflammation, or foreign infection. Interlinked causes urinary tract and skin trauma caused by urinary tract infection is rare.
Third, self-defense mechanism of urinary tract
Although the bacteria can enter the bladder, but not all cause urinary tract infections, urinary tract itself, which exists mainly to prevent bacterial adhesion, the mechanism of inhibition of bacterial growth. Are: urethra, genital skin and mucous membranes, such as the distribution of the normal flora of Lactobacillus, Streptococcus, Staphylococcus, Corynebacterium and other small inhibit the growth of pathogenic bacteria; unobstructed urinary tract, urination, urine flow of the mechanical washing effect; terminal male urination, the prostate contraction, discharge of prostatic fluid in the posterior urethra, a bactericidal effect; urinary tract mucosa disinfection, organic acids and secreted IgG, IgA, and by phagocytic cells to sterilization. Such as urinary Tamm-Horsfall protein can inhibit the bacteria and urinary tract epithelial receptor binding, and prevents bacterial adhesion in the epithelium, urinary bladder surface glycosaminoglycan oligosaccharides and can prevent bacterial adhesion in urinary tract epithelium; urinary in the low pH value, containing high concentrations of uric acid and organic acids, urine is too low and the high Zhang Zhang, are not conducive to bacterial growth; urinary tract epithelial cells of the blood antigen genes to resist bacterial adhesion.
Fourth, predisposing factors
(A) of the urinary tract obstruction
Common organic urinary tract obstruction (such as stone obstruction, tumor compression, etc.) or functional obstruction (such as vesicoureteral reflux); urine there is a foreign body (such as stones, stay catheters, etc.); or renal parenchymal disease (eg diabetic nephropathy , polycystic kidney disease, etc.). Sense of the incidence of urinary obstruction than the non-high 12 times.
(B) structural abnormalities of urinary tract and urinary tract malformations
Such as polycystic kidney, horseshoe kidney, renal hypoplasia and other developmental abnormalities; renal pelvis, renal calices, ureter, urinary tract abnormalities; vesicoureteral reflux, the more vulnerable to bacterial invasion.
(C) urinary tract examination and use of equipment
Such as catheterization or catheterization, cystoscopy, retrograde pyelography and so on. According to statistics, a catheterization, urinary tract infection rate was 1% to 3%; indwelling catheter infection rate of 50% 1d; indwelling catheter infection 3 to 4 days more than 90%; long-term indwelling catheter inevitably bacteriuria, of which 2% to 4% of severe sepsis.
(D) of the urethra or urethral inflammatory lesions around the mouth
Gynecological inflammation, urinary tract next to the pancreatitis, bacterial prostatitis Dengjun easy to cause urinary tract infections. Bacterial prostatitis which the young men urinary tract infection the most common predisposing factors.
(E) the body resistance is low
Such as diabetes, pregnancy, anemia, chronic liver disease, chronic kidney disease, malnutrition, pain and congenital immune deficiency or long-term immunosuppression therapy. Diabetic patients with increased risk of urinary tract infection, diabetes, glucose metabolism may result in urine concentration, white blood cell dysfunction, obesity prone, genital inflammation, diabetes, kidney disease and so on.
(F) of the predisposing factors of gender
The incidence of urinary tract infection of women is much higher than males, and women of local anatomy and physiology are closely related. Such as: female urethral short (3 ~ 5cm), straight and wide, weak urethral sphincter function; urethra and anus and vagina close; menstrual period genital easy to breed bacteria breeding; sexual life meatal retraction or compression trauma ; pregnancy pelvis, calyces and pelvis above the entrance parts of the ureter expansion, the latter the uterus increases, the obstruction caused by ureteral compression; postpartum vaginal and uterine trauma, infection, lowered immunity; menopause, estrogen reduce urethra epithelium induced , mucosal degeneration occurred, IgA, and organic acids to reduce, inhibit the ability of bacteria decreased and so on. In addition, associated with chronic gynecological disease (such as vaginitis, cervicitis, pelvic inflammatory disease and accessories go far) may pass through the lymphatic pathway of bacterial infection or urethral discharge pollution.
Men younger than 50 years of age rarely UTI, but there are structural abnormalities or functional urinary tract abnormalities, homosexuality, AIDS is UTI more common. Men older than 50 years of age is often associated with urinary tract infection, urinary tract obstruction caused by prostatic hypertrophy, or pathogens, a direct violation of the prostate.
Fifth, bacterial virulence
After the bacteria enter the bladder, can cause urinary tract infections, has a lot to its virulence.(A) of the lower urinary tract infection
Typical of acute lower urinary tract infection usually presents with acute cystitis, urinary tract irritation main symptoms (frequency, urgency, dysuria), and urinary discomfort, usually after the bladder trigone and stimulated by urethritis. Usually no fever and kidney pain in the area. More acute cystitis caused by the ascending infection, accompanied by acute urethritis. More urgency associated with dysuria, urination, bladder and urethra that part of the burning. Some patients with lower urinary terminal abdominal pain. Turbid urine tests can be found in urine, urine leukocytosis, occasional hematuria (microscopic hematuria and gross hematuria.)
Recurrent UTI over 1 year or more, it is called chronic UTI. Chronic UTI at some stage in their disease can be acute. The performance of long-term chronic cystitis recurrent urinary frequency and urgency symptoms, but symptoms of mild, moderate and, sometimes can be acute. Urine to be investigated to see the little amount of pus in the. More than a history of acute cystitis. Many of which were associated with stones, malformations or other obstructive factors exist, it should be further checked, and found the cause, incentives or complications.
(B) acute upper urinary tract infection (acute pyelonephritis)
Typical of acute upper urinary tract infection (ie, acute pyelonephritis) symptoms of chills, fever, back pain, you can with frequency, urgency, dysuria, and urinary discomfort symptoms of lower urinary tract infection, significant pain knocked on kidney area, elevated white blood cell count and more, may have hematuria and pyuria, urine white blood cell casts can be found. Often nausea, vomiting, some patients may have nocturia increased bacteremia were more common.
Three groups of patients with typical clinical manifestations often: urinary tract irritation, urinary urgency or dysuria. systemic symptoms: fever, chills, fatigue, anorexia, may have nausea, vomiting, or abdominal pain, increased blood neutrophils, and sometimes misdiagnosed as acute cholecystitis or acute appendicitis and other acute abdomen. Acute pyelonephritis complicated sepsis can occur often in diabetic patients with acute renal papillary necrosis may occur, shedding of renal papillary ureteral obstruction, which often leads to severe sepsis or acute renal insufficiency. Local symptoms: unilateral or bilateral renal pain, spinal pain and rib area with percussion tenderness, in addition to points in the quarter rib (costal margin and crossing the center line of the clavicle) and the ureter point (the outer edge of flat umbilical rectus Office) may have tenderness.
In clinical practice, there are many very typical symptoms difficult to distinguish between upper and lower urinary tract infection. Lower urinary tract infection may not have frequent urination, urgency, dysuria, and urinary tract irritation and other discomfort; acute pyelonephritis can be no fever and renal pain in the area. In a lower urinary tract irritation and the patients with true bacteriuria, only 50% to 70% infection confined to the bladder, the remaining 30% to 50% of the patients with occult upper urinary tract infection. Therefore, for purely clinical work in the performance of patients with lower urinary tract infection, also need to guard against concealed the existence of upper urinary tract infection.
(C) Chronic pyelonephritis
Chronic pyelonephritis is a chronic interstitial nephritis associated with renal scarring and recurrent urinary tract infection. Of childhood urinary tract infection and for recurrent urinary tract structural abnormalities associated with patients, almost all patients with chronic pyelonephritis. For there is no structural abnormalities of the reproductive tract, but repeated episodes of urinary tract infection patients, less likely to cause chronic renal insufficiency.
Clinical manifestations of chronic pyelonephritis can be divided into five types: relapse type: this type of symptoms are more typical. Patients with recurrent urinary tract irritation, accompanied by bacteriuria. Often low-grade fever, mild or moderate pain in kidney area. Long-term low-heat type: long-term low-grade fever, and dizziness, fatigue, weight loss, and loss of appetite and other symptoms, no urinary tract irritation, and sometimes misdiagnosed as tuberculosis or other chronic diseases. type of hypertension: a history of urinary tract infections, mainly as dizziness, headache and fatigue, characterized by high blood pressure symptoms. May be associated with proteinuria and anemia, may have impaired renal function, often without urinary tract irritation, may have intermittent bacteriuria or sterile urine. hematuria Type: A few, characterized by recurrent hematuria, urine dark and muddy, many accompanied by backache and back pain, blood in urine can be self-limiting, the general morphology of urinary red blood cells are normal. asymptomatic bacteriuria type: patients with no systemic symptoms and urinary tract irritation, urine, and a small amount of bacteria can be detected in white blood cells.
Second, the laboratory
(A) of the blood and urine samples checked
1. Urine routine examination of urine microscopy UTI can be found when the increase in white blood cells, fresh centrifuged urine sediment examination in the past that WBC 10 / high power field as pyuria. Counting method is more quantitative, fresh non-centrifugal disk check of urine with blood cell count, WBC 10/ml as pyuria. Pyuria suggest urinary tract infection, the sensitivity and specificity was 75%. When UTI can also have red blood cells in urine, but if a large number of flat epithelial cells are prompted to collect specimen contamination.
2. Urine bacterial smear is characterized by rapid, simple and reliable. Methods for the use of centrifugation or centrifuged urine sediment microscopic examination of urinary sediment can be stained Gram stain or methylene blue, or even direct microscopic examination without staining, the number of 1 bacteria / high power field were positive (10 vision should be continuously observed .) Cleaning positive urine culture, approximately 80% of the colony counts 105/mm3, particularly centrifugal Urine Gram stain consistent rate of up to 97%.
3. Urine bacterial culture quantitative bacterial culture clean urine colony counts 105/ml for the true bacteriuria, urinary tract infection that was not caused by contamination of samples collected. Recently, however, found by the standard diagnostic sensitivity of only 50% of UTI. Now that the situation in several other, they can diagnose true bacteriuria (Table 3-3-1).
Table 3-3-1 basis for the diagnosis of true bacteriuria
A.C.D.4. Renal function tests should pay attention to timely check the blood urea nitrogen (BUN), serum creatinine (SCr) and renal tubular function to prevent the acute and chronic renal insufficiency and renal tubular acidosis missed.
(B) imaging
Examination, including urinary tract urinary tract 1.X line X-ray, intravenous urography, retrograde urography, voiding the bladder ureter imaging, etc., with the aim to understand the urinary tract, so as to clear the need for surgical treatment or change in treatment program. For the first time urinary tract infection in women occur in principle not to do X-urinary examination; for women with recurrent UTI, if antibiotic treatment is not good, or having hematuria, or suspected renal papillary necrosis, renal abscess, renal tumors should be X-ray of urinary tract examination.
2.B ultrasound examination can find structural abnormalities of the urinary tract, such as obstruction, hydronephrosis, polycystic kidney disease, etc., simple, reliable, easy to accept the patient, especially for children, UTI in children and adults should be used as a routine examination.
3. The other for more complex cases can be considered further to do CT, MRI, or radionuclide scintigraphy.
Diagnosis and differential diagnosis
First, the diagnosis of urinary tract infection
(A) diagnostic criteria
Basically in accordance with the second 1985 National Kidney Disease standards adopted by the Conference.
1. Regular clean midstream urine (to ensure retention of urine in the bladder more than 4 ~ 6h) quantitative bacterial culture 105/ml.
10/HP, or a significant urinary tract irritation.
With the first 2 points can be confirmed, if not 2, then a urine culture colony count is still 105/ml, and for the same species, can be confirmed. Or:
3. Bladder puncture urine culture is positive (no matter how many), can be diagnosed.
1 (oil immersion field), can be combined with clinical diagnosis.
5. Urinary quantitative culture should be between 104 ~ 105/ml in the re, such as between 104 ~ 105/ml still can be done with clinical diagnosis or bladder puncture urine culture.
Positive quantitative culture of urine bladder puncture (whether the number of number of colonies) is the gold standard for diagnosis of urinary tract infection.
(B) Diagnostics
1. Understand the patient personal information including age, gender, height and weight, the presence of predisposing factors and concomitant diseases such as diabetes, kidney disease, urinary stones, urinary tract obstruction, reflux nephropathy, blood diseases, immune deficiencies, etc.
2. To master history, including past history, present illness, personal history, family history, which is associated with the incidence of diagnostic information.
3. Analysis of clinical manifestations, including systemic and local symptoms and signs.
4. The use of various diagnostic techniques, including conventional diagnostic techniques such as urine sediment examination, urine culture, urine Gram stain smears and various other special examinations, as quickly as possible, accurate and economical to make judgments. Possible renal biopsy under special circumstances, the diagnosis relies on pathology specimens.1. Non-bacterial urinary frequency - urinary distress syndrome. There is frequent urination, urination discomfort, and repeated quantitative culture negative, but ruled out the possibility of false positives. Appears to have a "healthy" populations, such as the urgency, chief complaint of urinary discomfort, then about 70% of patients with pyuria and bacteriuria in patients with urinary tract infection is the real and the other about 30% of patients, is the urethral syndrome . Two cases of the syndrome: leukocytes in urine were, after the exclusion of renal tuberculosis may be diagnosed as the urethral syndrome caused by microorganisms, the pathogens Chlamydia trachomatis and other microorganisms, mostly; were no white blood cells in urine, mostly The urethral syndrome caused by non-microbial, and its cause is unknown, may be an anxiety state of mind.
2. Some of urinary tract infection in renal tuberculosis as the main performance hematuria, bladder irritation was misdiagnosed as renal tuberculosis. However, the bladder irritation of renal tuberculosis is more prominent, and morning urine culture can be positive for Mycobacterium tuberculosis, and common bacterial cultures were negative. Urine can be found in acid-fast bacilli can be found in IVP X ray findings of renal tuberculosis. Some patients may have lung, genital and renal tuberculosis treatment of tuberculosis outside the efficient identification of such can be funded. Note, however, renal tuberculosis often coexist with normal urinary tract infection, therefore, such as urinary tract infection after active antibiotic therapy, there are still frequent urination - urination discomfort or abnormal urinary sediment, there should be a high degree of attention to the possibility of renal tuberculosis , should be checked accordingly.
Treatment Western
First, principles of treatment of urinary tract infection
(A) of the first site of infection before treatment, the nature and the existence of predisposing factors for initial judgments.
(B) give priority to traditional Chinese medicine, Chinese medicine can not cure in the pure case before considering the application of antibiotic treatment, against the abuse of antibiotics.
(C) should be treated with antibiotics before the bacteria in quantitative culture or Gram stain of urine to confirm the diagnosis, but sensitivity test, to further guide treatment.
(D) reasonable access to the best treatment effect in the premise, adverse reactions, the price is cheap. In the absence of susceptibility test results should be used for Grande were negative bacilli effective antimicrobial drugs, such as do not have to change the effective drugs. Currently available antibiotics for the treatment of urinary tract infection include: penicillins, methyl benzyl ammonium pyrimidine (TMP), sulfamethoxazole, cephalosporins, quinolones, aminoglycosides and imipenem (imine sulfur sp Su), aztreonam and so on. Since ampicillin (ampicillin), the first generation cephalosporins resistant strains increased significantly, it is not appropriate as first-line treatment of urinary tract infection drug experience. Cotrimoxazole and quinolones on the most sensitive bacteria in urinary tract infection, the experience can be used as first-line drugs. The third generation cephalosporins, imipenem and aminoglycoside antibiotics can be used as the experience of complicated urinary tract infection medication. Aminoglycoside antibiotics are nephrotoxicity, ototoxicity, usually after the injection of a single oral administration to other antibiotics, can maintain its efficacy and reduce side effects.
(E) no effect of attention to antibiotic therapy antibiotic resistance, and other pathogenic microorganisms infections (such as fungi, tuberculosis, etc.) and whether there is obstruction, stones and other complex factors. In recent years, quinolone antibiotics, sulfa drugs and drug-resistant strains has increased, especially in the elderly. Therefore, complicated urinary tract infection, long-term indwelling catheter, and previous quinolone antibiotics used, treatment for urinary quantitative culture as much as possible in order to understand the pathogen and its drug susceptibility. In recent years, found that some intestinal bacteria such as E. coli, Klebsiella pneumoniae and Pseudomonas aeruginosa, etc. can produce extended spectrum -lactamases, the hydrolysis of the second generation cephalosporins, and gentamicin, a new compound sulfamethoxazole, ciprofloxacin, amoxicillin (amoxycillin), clavulanate potassium (potassium bars) and other cross-resistance to antibiotics, sensitive only to imipenem, should arouse the clinician attention.
(Vi) clinical remission does not indicate bacteriological cure, should be 1 week after treatment and 1 month re, to see whether the cure.
(Vii) the treatment of urinary tract infection should be based on a sense of the different types of urine to be a different treatment.
(H), while in the rational use of antibiotics, should be compatible with non-antibiotic treatment, such as to ensure adequate urine output, urinary tract as far as possible to avoid damage to their own local defense mechanisms that regulate the urinary pH value and so on.
(Ix) encourage patients to drink plenty of water, urinating frequently, not holding back urine, to reduce the medullary osmotic pressure, improve the body phagocytic cell function, and flush out the bacteria in the bladder. Fever and other symptoms of systemic infection should stay in bed.
Second, depending on the type of treatment
(A) the treatment of acute lower urinary tract infection
Simple cystitis, the bladder infection confined to the superficial mucosa, effective treatment depends on the antibiotic concentration in urine, but not with the organization independent of the concentration of antibiotics. Now for acute simple cystitis women use more short-range therapy, ie oral antibiotics for 3 days. Commonly used antibiotic trimethoprim - sulfamethoxazole (TMP-SMZ) and fluoroquinolones (eg norfloxacin, ciprofloxacin, ofloxacin). Some people have advocated single-dose therapy, but can not effectively remove the intestinal and vaginal tract pathogens in parasitic and therefore a higher relapse rate; the course of more than 5 days to increase not only the opportunity to produce drug-resistant, but not significantly improve the efficacy of . -lactam antibiotics because the more resistant, and can damage the normal intestinal and vaginal flora in the growth and promotion of the growth of urinary tract pathogens, and thus the relatively poor efficacy.
Must be emphasized that only short-term therapy for urinary infection in the superficial mucosa, but does not apply to the following conditions: pyelonephritis; male UTI; course of more than 7 days; exist structural or functional urinary tract abnormalities; immunosuppression; retained catheter; possible existence of drug-resistant infections. Treatment of women with simple cystitis, urine culture may not have to do, if the patient symptoms, then the cure; If symptoms persist, urine culture should be further done, culture-positive and then re-treatment based on susceptibility test results for 14 days; if culture negative However, microscopic examination with pyuria, C. trachomatis infection should be suspected to be caused by acute urethral syndrome, tetracycline, or sulfa treatment can be 7 to 14 days, while treatment of their sexual partners, otherwise there will be cross infection.
Acute urinary tract infection in pregnant women and other women in similar treatment. Asymptomatic bacteriuria, acute cystitis can be used short-range therapy. Should be selected on the fetal safety of antibiotics such as cephalosporins and penicillins, and sulfonamides, quinolones, trimethoprim, nitrofurantoin, tetracycline should not be used.
Man with acute urinary tract infection is not suitable for single-dose therapy, the general TMPco or fluoroquinolone treatment for 2 weeks. After conventional treatment for cases of infections, prostatitis should be on high alert. The treatment of bacterial prostatitis more difficult, mainly due to antibiotics is more difficult to enter the prostate through prostatic epithelial cells in fluid, another is often accompanied by repeated infection stones or calcification, can block the discharge of prostatic fluid. Therefore, treatment should be positive. For more acute prostatitis first intravenous use of antibiotics after 1 to 2 weeks after symptoms, oral antibiotics can be changed to 4 to 6 weeks, some patients need treatment for 12 weeks. Oral antibiotics or trimethoprim compound fluoroquinolones better effect can also be selected according to susceptibility of other antibiotics. For recurrent cases, consider long-term low-dose oral antibiotic prophylaxis sensitive.
(B) the treatment of acute pyelonephritis
Acute pyelonephritis and cystitis is different and deep tissue infections, bacteremia often, and even sepsis, infection control symptoms should be promptly. Therefore, effective treatment requires not only high concentration of antibiotics in urine, also require higher plasma concentrations. Systemic toxic symptoms with acute pyelonephritis in patients with intravenous antibiotics should be hospitalized. In addition to asking the complicated factors of this infection, but also water and electrolyte status as soon as possible to be conditioning. Intravenous fluids to increase urine output, and correct function of the heating and loss of urine concentration caused by insufficient capacity. In obtaining urine culture, blood culture results, and refer to urine analysis and the results of Gram stain, patients are most likely pathogens to implement treatment.
Therapy is often divided into two steps: first, the rapid intravenous broad-spectrum antibiotics to control infection with symptoms of poisoning, and then oral antibiotics until cured. Routine cleaning should be done before treatment urine culture, and then immediately given intravenous broad-spectrum antibiotics. Many antibiotics are available, such as fluoroquinolones, cephalosporins, aztreonam, -lactam / -lactamase inhibitor and so on. 24h after the temperature is normal, oral TMP-SMZ or fluoroquinolones, treatment for 14 days.
Currently available for drug treatment of acute pyelonephritis is not only a second, third and fourth generation cephalosporins, newer antimicrobial agents aztreonam, according to meters with energy, as well as -lactamase inhibitor combination therapy such as combination therapy for Ravi acid. The advantages of these agents with both gram negative bacilli (including Pseudomonas spp) resistant strains of the good effect, but also avoid the nephrotoxicity of aminoglycoside antibiotics. The drug treatment of nosocomial infection caused by pyelonephritis particularly effective. Quinolones norfloxacin (norfloxacin) and the treatment of urinary tract infections ciprofloxacin has excellent antibacterial activity and pharmacokinetic characteristics. Enterococcus urinary tract infection caused by the general application of ampicillin (ampicillin) treatment to obtain good effect, but combined with a sepsis who need additional aminoglycoside antibiotics. Staphylococcus saprophyticus infection sulfamethoxazole, ampicillin or vancomycin treatment are very sensitive.
In the treatment of acute pyelonephritis, intravenous antibiotics should be continued fever 48h, and then give effective oral antibiotics for at least 2 weeks. To have recurrent urinary tract infection or urinary tract structural abnormalities associated with patients, antibiotics should be continued 4 to 6 weeks. General If, after appropriate antibiotic therapy, 72h in patients with fever can be; if fever even after 72h, you will need further examination, to exclude local purulent infection (such as kidney or renal abscess, renal papillary necrosis, etc.) or urinary tract obstruction. CT or ultrasound examination of renal abscess diagnosis can provide good information, and percutaneous abscess drainage is also a guiding role.
Uncomplicated pyelonephritis can be applied to a variety of antimicrobial agents for treatment. Given parenteral ampicillin. Cefazolin (Vanguard V), or oral sulfamethoxazole, are a better choice. Gram-negative bacteria of sepsis associated with severe infections, or nosocomial infection (such as Pseudomonas infection), then in addition to -lactams, but also combined aminoglycoside antibiotics. Antibiotic treatment according to the results of susceptibility testing for bacteria to further adjustments. A good treatment program should be the most simple, most effective and inexpensive. Antimicrobial treatment of acute pyelonephritis disable week later, urine culture should be done promptly followed up. Found more stubborn infection, then antibiotic treatment should be continued 4 to 6 weeks.
If the Department of the complexity of acute pyelonephritis caused by UTI, the broad spectrum of bacteria, more resistant, and often the abnormal structure of the urinary tract to reduce the effectiveness of antibiotic treatment. In addition to antibiotic treatment, the key is surgery to remove the obstruction, or removal of foreign body. As the complexity of a broad spectrum of urinary tract infections and resistant pathogens are more chances of infection, urine culture must be done before treatment. Pending the outcome of the training to use broad-spectrum antibiotics, pending culture results came out adjusted according to antibiotic susceptibility. To the acute phase after 2 weeks of oral antibiotic therapy. If the same surgical treatment, treatment should be extended to 4 to 6 weeks. For recurrent infections may be considered a small amount of long-term oral antibiotic prophylaxis.
Recurrent urinary tract infections, whether male or female, should be checked by the Department of Urology, except treatment of urinary tract structural abnormalities can be. If the recurrence of acute pyelonephritis system infection and re-infection, the treatment is often longer. For recurrent infections, usually based on susceptibility test results to select the appropriate antibiotic treatment for 6 weeks. For re-infection, in addition to treating each attack, we must also take preventive treatment. In the preventive treatment, should be to remove risk factors, such as the use of cervical caps, spermicidal contraceptive ointment, urinating immediately after sexual intercourse can be squeezed into the urethra due to mechanical removal of pathogens. If still valid, you can give sulfamethoxazole tablets before bedtime half, 3 times / week, for some patients after the medication could be considered sexual intercourse. Small dose of fluoroquinolones can play the same effect. In addition, Nitrofurantoin 50mg before bedtime, or large doses of vitamin C oral methenamine (acidification of the urine), also have a certain effect. Preventive treatment is usually 6 months.
(C) the prevention and treatment of chronic pyelonephritis
The optimal treatment of chronic pyelonephritis is to prevent its occurrence. Structural abnormalities of the urinary tract should be diagnosed and treated promptly to prevent the occurrence of chronic pyelonephritis. Urinary tract infection of children, adult men or women with recurrent urinary tract infections, and patients with renal dysfunction, a detailed urological examination should be done, and the early detection and treatment of urinary tract obstruction can damage.
Accompanied by a variety of structural abnormalities of the genitourinary system in patients with urinary tract infection to fully control the often difficult to achieve. Recommended treatment is: given during the acute infection of 10 to 14 days of antibiotic therapy to eliminate the symptoms and prevention of systemic infection. Longer a sense of antimicrobial therapy on recurrent urinary and patients with renal scarring can sometimes receive treatment. 6 to 12 weeks of oral sulfamethoxazole, or a quinolone, or use the urine acidification Meng Deli amines can often be effective. But continued treatment is not to be encouraged, because this treatment can produce selective inhibition, resulting in strains resistant to antibiotics.
In case of chronic renal insufficiency, anemia, high blood pressure, the time to give appropriate treatment.
Third, the prevention of urinary tract infection
Urinary tract infection pathogenic invasion mainly through ascending infection, so preventive measures are as follows:
(A) drink plenty of water every day, urinate every 2 to 3 hours once to flush the bladder and urethra, to prevent breeding of bacteria in the urinary tract, which is the most practical and effective methods of prevention.
(B) Note that genital hygiene to reduce bacteria in the urethra groups, especially female patients, in menstruation, pregnancy and puerperium, particular attention should be. Men such as phimosis, should pay attention to cleanliness, should be treatment of phimosis.
(C) of the urinary tract as far as possible avoid the use of equipment, necessary to strictly aseptic technique. Equipment used in the urinary tract after 48 hours, quantitative bacterial culture of urine should be to observe whether the urinary tract infection. Has been used before in bacterial urinary tract devices, should first control the infection. In the past, the history of recurrent urinary tract infection or urinary tract abnormalities in the urinary tract devices should be checked 48 hours before and after taking antibiotics to prevent infection.
(D) must indwelling catheter, in the first 3 days to give antibiotics can delay the occurrence of urinary tract infection, but only after 3 days if no preventive effect of medication.
(E) and sex-related recurrent urinary tract infection, which should be in urination after sex, according to the usual dose of oral administration of a dose of antibiotics as a precaution. According to Asscher statistics, efficiency up to 80%.
(Vi) more frequent episodes of urinary tract infection in women, such as night service can be a preventive dose of antibiotics can also reduce the recurrence rate of urine flu. Preventive services antibacterial drugs, can choose cotrimoxazole, nitrofurantoin, amoxicillin, or cephalosporins and other drugs in one. If no side effects, available to more than 1 year.
Chinese Medicine
In the treatment of disease in accordance with the spirit of Dharma, not only the onset of urinary tract infections in need of treatment, remission also need treatment. Exacerbation and remission are at different stages of the disease, the clinical onset of clearing heat with ease of replenishing spleen and kidney, with emphasis on sequential therapy of Chinese medicine in remission, so that urinary tract infections are treated with the standard.
First, the attack
Including acute urinary tract infection and acute exacerbation of chronic urinary tract infection, the clinical to frequency, urgency, dysuria, cloudy urine, back pain, chills and fever, occasionally characterized by hematuria, red tongue, yellow greasy moss, pulse slippery.
1. Bladder damp heat
Main symptoms: frequent urination, tingling short Shibuya, drip down, urgent burning, drowning, yellow red, Juji lower abdomen pain, chills or fever, mouth pain Oue, or abdominal pain, refused to press, or constipation, red tongue, yellow greasy moss, pulse a few slip. For the heat toxin, Accumulation bladder, gasification loss Secretary, due to adverse channel.
Governing Law: detoxification, dampness Tonglin.
Recipe: diffusa 30g, soil Fuling 30g, forsythia 20g, dandelion 20g, Shan Gardenia 15g, Scutellaria 15g, Bian storage 15g, Dianthus superbus 15g, Alisma 15g, talc 30g, aggregata 15g, habitat 15g.
2. Hepatobiliary swelter
Main symptoms: cold and heat exchanges, bitter mouth, dry throat, upset vomit, not eating, frequent urination and pain, female yellow red, lower abdomen pain, red tongue or greasy yellowish, pulse a few strings. Violations of the liver and gallbladder damp heat, caused by adverse Shaoyang Cardinal.
Governing Law: clear liver and gallbladder damp heat diarrhea.
Recipe: gentian 10g, Chai Hu 12g, Alisma 12g, plantain seed 15g (cloth), through the grass 6g, habitat 12g, angelica 15g, Shan Gardenia 10g, Scutellaria 10g, licorice 6g.
3. Triple burner heat
Main symptoms: chills, fever, very hot afternoon, the body weight of pain, chest tightness, not hungry, do not want to drink dry mouth, abdominal fullness, when the sense of nausea Yu Tu, cloudy urine, urinary pain when the astringent, thick and greasy tongue coating or yellow and greasy How to number or slippery. The damp heat evil, violating triple burner, heat block, due to unfavorable gasification.
Governing Law: Xuan Li triple burner, Thanh Hoa hot and humid.
Recipe: Almond 10g, Health Yiyiren 30g, Bai Kou Ren 12g, Magnolia 10g, Pinellia system 9g, White Pass grass 6g, talc 30g, bamboo 9g, Polyporus 15g, 15g Pulsatilla
Second, the remission
Acute symptoms have been alleviated, more than 6 months duration, urination discomfort is not obvious, a sense of low back pain, fatigue, weakness, often induced by exertion or cold and other acute urinary tract infection.
1. Spleen and kidney qi deficiency
Main symptoms: fatigue fatigue, poor appetite bloating, backache back pain, frequent urination clear long or nocturnal enuresis, stool softer, when a sense of stagnation urination, but not very significant, pale tongue, thin white fur, thin weak pulse. For the lack of ferrite spleen, or ill for a long upright deficiency, caused by wet endogenous stasis.
Governing Law: spleen and kidney, Tonglin stasis.
Recipe: Raw Astragalus 30g, white dried ginseng 15g, Bai Zhu 15g, Poria 15g, Alisma 15g, Fructus Corni 15g, habitat 15g, wolfberry fruit 15g, Bian storage 15g, Dianthus superbus 15g, red peony root 15g, paeonol 15g.
2. Liver and kidney
Main symptoms: dizziness, ringing in the ears, rather then the headaches, hot flashes, night sweats, five upset hot, dry mouth, dry lips, waist pain, short astringent and yellow urine, high blood pressure, thin yellow tongue coating or less reddish fur, the pulse fine or thin string. Under long-Yun Jiao for the hot and humid, hot Sheng Shangyin, wet Sheng Yonge, cause of the lack of s, liver and kidney.
Governing Law: Ziyinqingre dampness.
Recipe: Anemarrhena 9g, Phellodendron 9g, Rehmannia 12g, Chinese yam 15g, cornus 9g, paeonol 12g, Poria 15g, Alisma 12g, Ligustrum lucidum 12g, Eclipta prostrata 12g, plantain seed 10g, Motherwort 18g.
3. Qiyinliangxu
Main symptoms: yellow and turbid urine stagnation astringent, urinary different meaning, or dripping poor, recurrent, lingering disease, malaise, fatigue, less gas lazy words, lumbar pain, fever, dry mouth, but do not want to drink, or hot hand-foot-heart, tongue mass of small red tongue, thin white moss moss or less small-chun, thin or weak pulse. Heat for a long time for the custodial, or clearing too dark consumption Qi Yin, causing Qi and Yin Deficiency, due to nostalgia than evil.
Governing Law: Qi Yin, accompanied heat Lishi.
Chinese yam 30g, Codonopsis 15g, Radix Astragali 15g, Poria 15g, Radix 30g, medlar 15g, Ligustrum lucidum 15g, Eclipta prostrata 15g, Rhizoma Imperatae 20g, plantain seed 10g, Shi Wei 30g, Dioscorea collettii 15g, Baked Licorice 6g.
4, the hot and humid over evil
Main symptoms: when frequent urination, yellow red, dripping endless, abdominal discomfort, dry mouth, thirst, dry bowel movements, body sleepy, red tongue, yellow greasy fur, slippery pulse string. Is not entirely over evil, hot and humid to stay, the next block coke gasification due to unfavorable.
Governing law: heat dampness Jieyu
Recipe: Gardenia 15g, Scutellaria 15g, Cork 15g, Alisma 15g, Rhizoma Imperatae 15g, Shi Wei 15g, Dioscorea collettii 15g, forsythia 15g, the British public 15g, Salvia miltiorrhiza 15g, aggregata 15g, 15g Citrus aurantium
Outcomes
Several prospective studies found that urinary tract infection usually does not cause renal damage and its blood pressure. Even if the formation of renal scars, no damage of the kidney increased, unless accompanied by hypertension, obstruction, diabetes, or abuse of painkillers.
Long-term study shows that children in the event of urinary tract infection, the prognosis depends on the extent of damage and whether the initial proteinuria. Proteinuria can be used to predict the extent of secondary an index of glomerulosclerosis. Children with chronic pyelonephritis is the most common cause of hypertension, high blood pressure in children, accounting for about 30% of adults are also a common cause of secondary hypertension. Before the diagnosis of bacterial urinary and renal scar formation within the school-age girls, as years and pregnant, their risk of high blood pressure three times higher than the others, the risk of suffering from eclampsia is also more than 7 times visible and its harmful consequences.



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