Valiquette L
Department of Surgery (Urology), CHUM-Hôpital St-Luc, Montréal, Québec, Canada.
Can J Urol. 2001 Jun;8 Suppl 1:6-12.
Urinary tract infections (UTIs) are the most common infections seen in the hospital setting, and the second most common infections seen in the general population. Due to women's anatomy, UTIs are especially problematic for them, and up to one-third of all women will experience a UTI at some point during their lifetimes. Appropriate treatment of a UTI requires accurate classification that includes infection site, complexity of the infection, and the likelihood of recurrence. The predominant pathogen in both complicated and uncomplicated UTI remains pathogenic Escherichia coli, although Klebsiella sp. and Proteus appear with increased frequency in complicated UTI. Most often, bacteria cause UTIs by ascending means through the urethra into the bladder. Bacteria must possess virulence factors to cause UTI. Host defense factors that predispose patients to UTI include urinary stasis, abnormal urinary tract anatomy, diabetes mellitus, debility, and aging. Estrogen-related issues and short urethras predispose women to UTI. Although urine culture, with >105 colony-forming units/mL (CFU/mL) in symptomatic patients, remains the diagnostic "gold standard," correlation of the patient's history and physical examination with urinalysis (including nitrite dipstick and leukocyte esterase test) results usually suffices to diagnose UTI. Three-day of antimicrobial treatment is recommended for simple cystitis. Acute pyelonephritis, an infection of the kidney parenchyma tissue, is treated with antibiotics for 7 to 14 days depending on the antimicrobial agent used and the severity of infection. In addition, patient classification determines the need for hospitalization or for urological imaging studies. Women with recurrent UTIs merit consideration for antimicrobial prophylaxis. Self-administered topical vaginal estradiol cream is an important adjunct in UTI prevention for postmenopausal women. Asymptomatic bacteruria only merits antimicrobial therapy in high-risk patients or those colonized with Proteus species.
尿路感染（UTIs）是医院环境中最常见的感染，也是普通人群中第二常见的感染。由于女性的解剖结构，尿路感染对她们来说尤其成问题，多达三分之一的女性在其一生中的某个时候会经历尿路感染。尿路感染的恰当治疗需要准确分类，包括感染部位、感染的复杂性以及复发的可能性。无论是复杂性还是非复杂性尿路感染，主要病原体仍然是致病性大肠杆菌，尽管克雷伯菌属和变形杆菌在复杂性尿路感染中出现的频率有所增加。大多数情况下，细菌通过尿道上行进入膀胱导致尿路感染。细菌必须具备毒力因子才能引起尿路感染。使患者易患尿路感染的宿主防御因素包括尿潴留、尿路解剖结构异常、糖尿病、身体虚弱和衰老。雌激素相关问题和尿道较短使女性易患尿路感染。虽然对于有症状的患者，尿培养菌落形成单位>105/mL（CFU/mL）仍是诊断的“金标准”，但患者的病史和体格检查结果与尿液分析（包括亚硝酸盐试纸和白细胞酯酶试验）结果相结合通常足以诊断尿路感染。对于单纯性膀胱炎，建议进行为期三天的抗菌治疗。急性肾盂肾炎是肾实质组织的感染，根据所用抗菌药物和感染严重程度，用抗生素治疗7至14天。此外，患者分类决定是否需要住院或进行泌尿外科影像学检查。复发性尿路感染的女性值得考虑进行抗菌预防。自行局部应用阴道雌二醇乳膏是绝经后女性预防尿路感染的重要辅助措施。无症状菌尿仅在高危患者或感染变形杆菌属的患者中才值得进行抗菌治疗。
