医学尿路感染医疗课件.ppt

尿路感染医疗讲义

IntroductionUrinarytractinfection(UTI)isthemostcommonofallbacterialinfections,affectinghumansthroughouttheirlifespan.NotonlyisUTIcommon,buttherangeofclinicaleffectsitcanproduceisexceptionallybroad,fromacutepyelonephritiswithgram-negtivesepsistoasymtomaticbacteriuria.

IntroductionUTIupperpelvic肾盂calyx肾盏ureter输尿管lowerbladder膀胱urethra尿道pyelonephritiscystitisurethritisFemale:male10:1

DefinitionUTI:abroadtermthatencompassesbothasymptomaticmicrobialcolonizationoftheurineandsymptomaticinfectionwithmicrobialinvasionandinflammationofurinarytractstructures.Acutepyelonephritis(急性肾盂肾炎):apyogenic,focalinfectionoftherenalparenchymaaccompaniedbylocalandsystemicsymptomsofinfection.Chronicpyelonephritis（慢性肾盂肾炎）:thepathologicandradiologicfindingsofchroniccorticalscarrings,tubulointerstitialdamage,anddeformityoftheunderlyingcalyx.

PathogenGram-negtiveenterobacteriaismostcommon95%E.coli大肠杆菌60-80%Proteusmirabilis变形杆菌Klebsiellasp克雷伯杆菌Pseudomonassp绿脓杆菌(urinarytractinstrumentation)Serratiasp沙雷杆菌Gram-positiveorganisms5-10%Streptococcusfaecalis粪链球菌Staphylococcusaureus金黄色葡萄球菌Staphylococcusalbus白色葡萄球菌Fungi真菌Yeasts原虫Viruses病毒

PossibleroutesofinfectionAscendinginfectionMostUTIarebelievedtooccurbytheascendingroute.urethra→bladder→ureter→pelvis→calyx→parenchymaHematogenousinfectionRelativelyrareStaphylococcalbacteremia金葡菌血症Intestinetokidneybywayoflymphatics盆腔器官炎症阑尾炎结肠炎Directinfection外伤肾周器官感染

Ascendinginfection：urethra→bladder→ureter→pelvis→calyx→parenchymaHematogenousinfection：circulation→parenchyma→calyx→pelvis

ThedefencemechanismofurinarytractValveatthejunctionofureterandbladder.Thedilutionandremovalo