尿路感染医学课件.pptx

尿路感染
程劲
尿路感染的流行病学
美国
急性膀胱炎每年就诊3600万(18-75y),治疗费用达16亿美元。
每1年11%妇女尿路感染。
妇女一生中50%-60%至少一次尿路感染。
普通人群 % 女性人群 %* 育龄妇女 %* 妊娠妇女 7% 婴幼儿细菌尿 % 女学生细菌尿 1-2% 男学生细菌尿 %  老年男性细菌尿 % 老年细菌尿 10%
*中山一院 30196普查女性结果
侵犯部位:
上尿路感染:主要是肾盂肾炎(acute pyelonephritis )
下尿路感染:主要是膀胱炎(acute cystitis )
临床治疗和预后不同:
急性女性非复杂性膀胱炎
急性女性非复杂性肾盂肾炎
再发性尿路感染:复发和重新感染
(6个月≥2次或1年内≥3次)
男性尿路感染
导管相关性尿路感染
无症状性菌尿
分类
尿路感染的病原学
细菌、病毒、真菌、衣原体、支原体等
细菌
主要致病菌大肠杆菌 75%-90%
其次腐物寄生葡萄球菌 5%-15%
少数是肠球菌、肺炎克雷白氏杆菌、绿脓杆菌
CASE 1 — A 32 year-old plains of dysuria and frequency; pyuria is seen in the urine sediment. Gram stain of unspun urine (x1000) shows an inflammatory cell and numerous Gram negative bacilli. Escherichia coli grew from this specimen.
CASE 2 — A 65 year-old plains of dysuria and frequency; pyuria is seen in the urine sediment. Gram stain of unspun urine (x1000) shows inflammatory cells and Gram positive i in chains. us faecalis grew from this specimen.
CASE 3 — An 18 year-old plains of dysuria and frequency; pyuria is seen in the urine sediment. Gram stain of unspun urine (x1000) shows inflammatory cells and Gram positive i in pairs and clusters. us saprophyticus(腐生) grew from this specimen.
CASE 4 — This specimen was obtained from a 42 year-old diabetic woman with a Foley catheter. Gram stain of unspun urine (x1000) shows Gram positive budding yeasts and large pseudohyphae. Candida albicans grew from this specimen.
发病机制
感染途径
机体的防御机能
易感因素
细菌的致病力