Foxman Betsy
Dis Mon. 2003 Feb;49(2):53-70. doi: 10.1067/mda.2003.7.
Urinary tract infections (UTIs) are considered to be the most common bacterial infection. According to the 1997 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, UTI accounted for nearly 7 million office visits and 1 million emergency department visits, resulting in 100,000 hospitalizations. Nevertheless, it is difficult to accurately assess the incidence of UTIs, because they are not reportable diseases in the United States. This situation is further complicated by the fact that accurate diagnosis depends on both the presence of symptoms and a positive urine culture, although in most outpatient settings this diagnosis is made without the benefit of culture. Women are significantly more likely to experience UTI than men. Nearly 1 in 3 women will have had at least 1 episode of UTI requiring antimicrobial therapy by the age of 24 years. Almost half of all women will experience 1 UTI during their lifetime. Specific subpopulations at increased risk of UTI include infants, pregnant women, the elderly, patients with spinal cord injuries and/or catheters, patients with diabetes or multiple sclerosis, patients with acquired immunodeficiency disease syndrome/human immunodeficiency virus, and patients with underlying urologic abnormalities. Catheter-associated UTI is the most common nosocomial infection, accounting for >1 million cases in hospitals and nursing homes. The risk of UTI increases with increasing duration of catheterization. In noninstitutionalized elderly populations, UTIs are the second most common form of infection, accounting for nearly 25% of all infections. There are important medical and financial implications associated with UTIs. In the nonobstructed, nonpregnant female adult, acute uncomplicated UTI is believed to be a benign illness with no long-term medical consequences. However, UTI elevates the risk of pyelonephritis, premature delivery, and fetal mortality among pregnant women, and is associated with impaired renal function and end-stage renal disease among pediatric patients. Financially, the estimated annual cost of community-acquired UTI is significant, at approximately $1.6 billion.
尿路感染（UTIs）被认为是最常见的细菌感染。根据1997年国家门诊医疗护理调查和国家医院门诊医疗护理调查，尿路感染导致近700万人次到门诊就诊以及100万人次到急诊科就诊，进而造成10万人住院。然而，准确评估尿路感染的发病率很困难，因为在美国它们并非须上报的疾病。这种情况因以下事实而更加复杂：准确诊断既取决于症状的存在，也取决于尿培养呈阳性，尽管在大多数门诊环境中，这种诊断是在没有培养结果的情况下做出的。女性比男性更易患尿路感染。近三分之一的女性在24岁时至少会经历1次需要抗菌治疗的尿路感染发作。几乎一半的女性在其一生中会经历1次尿路感染。尿路感染风险增加的特定亚人群包括婴儿、孕妇、老年人、脊髓损伤和/或使用导尿管的患者、糖尿病或多发性硬化症患者、获得性免疫缺陷综合征/人类免疫缺陷病毒患者以及有潜在泌尿系统异常的患者。导尿管相关尿路感染是最常见的医院感染，在医院和疗养院中占100多万例。尿路感染的风险随着导尿管留置时间的延长而增加。在非机构化的老年人群中，尿路感染是第二常见的感染形式，占所有感染的近25%。尿路感染有重要的医学和经济影响。在无梗阻、未怀孕的成年女性中，急性单纯性尿路感染被认为是一种良性疾病，不会产生长期医学后果。然而，尿路感染会增加孕妇患肾盂肾炎、早产和胎儿死亡的风险，并且与儿科患者的肾功能损害和终末期肾病有关。在经济方面，社区获得性尿路感染的估计年度成本很高，约为16亿美元。
