Neu H C
College of Physicians and Surgeons, Columbia University, New York, New York 10032.
Am J Med. 1992 Apr 6;92(4A):63S-70S. doi: 10.1016/0002-9343(92)90312-y.
The populations at risk for urinary tract infection include the newborn, particularly the premature, prepubertal girls, young boys, sexually active young women, elderly males, and elderly females. Risk factors that contribute to lower tract infection in women include sexual intercourse, diaphragm-spermicide use, and voiding behavior. Host factors, more than bacterial virulence, are probably the most important contributors to infection. The genetic factors that are important contributors are secretor status and P blood group phenotype. Which patients to culture, when to culture, and the number of organisms required to define infection have changed in the past decade. A concentration of 10(2) colony forming units/mL can cause an acute urinary tract infection in the healthy woman. The presence of leukocytes in the urine is of increasing diagnostic importance. Complicated urinary tract infections occur in neonates with such congenital anomalies of the urinary tract as urethral valves or in patients with neurologic disease resulting in urinary stasis. In older men or women, complicated urinary tract infections occur with obstruction, instrumentation, surgery, anatomic abnormalities, or stones. Single-dose therapy of uncomplicated urinary tract infection is useful in only a small subset of patients, specifically in patients less than 45 years of age who have short duration of symptoms. The majority of patients with uncomplicated infections should receive treatment for 3-5 days. Response to therapy and long-term cure rates in complicated urinary tract infection are related both to the type of underlying abnormality and to the species of the infecting organism. Complicated urinary tract infections should be treated for 7-14 days.
易患尿路感染的人群包括新生儿，尤其是早产儿、青春期前女孩、幼龄男孩、性活跃的年轻女性、老年男性和老年女性。导致女性下尿路感染的危险因素包括性交、使用阴道隔膜-杀精剂以及排尿行为。宿主因素而非细菌毒力可能是感染的最重要促成因素。重要的遗传因素是分泌状态和P血型表型。在过去十年中，哪些患者需要培养、何时培养以及确定感染所需的微生物数量都发生了变化。每毫升10²个菌落形成单位的浓度就可在健康女性中引发急性尿路感染。尿液中白细胞的存在在诊断上的重要性日益增加。复杂尿路感染发生于患有诸如尿道瓣膜等先天性尿路异常的新生儿，或患有导致尿潴留的神经系统疾病的患者。在老年男性或女性中，复杂尿路感染发生于存在梗阻、器械操作、手术、解剖异常或结石的情况下。单纯性尿路感染的单剂量疗法仅对一小部分患者有用，特别是症状持续时间短的45岁以下患者。大多数单纯性感染患者应接受3至5天的治疗。复杂尿路感染的治疗反应和长期治愈率既与潜在异常的类型有关，也与感染微生物的种类有关。复杂尿路感染应治疗7至14天。
