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泌尿道感染的诊断与治疗执行摘要:西班牙临床微生物学和传染病学会(SEIMC)指南

Executive summary of the diagnosis and treatment of urinary tract infection: Guidelines of the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC).

作者信息

de Cueto Marina, Aliaga Luis, Alós Juan-Ignacio, Canut Andres, Los-Arcos Ibai, Martínez Jose Antonio, Mensa Jose, Pintado Vicente, Rodriguez-Pardo Dolors, Yuste Jose Ramon, Pigrau Carles

机构信息

Unidad Clinica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocio, Sevilla, Spain.

Unidad de Gestión Clínica de Medicina Interna, Hospital Universitario Unificado de Granada, Granada, Spain.

出版信息

Enferm Infecc Microbiol Clin. 2017 May;35(5):314-320. doi: 10.1016/j.eimc.2016.11.005. Epub 2016 Dec 23.

Abstract

Most urinary tract infections (UTI) are uncomplicated infections occurring in young women. An extensive evaluation is not required in the majority of cases, and they can be safely managed as outpatients with oral antibiotics. Escherichia coli is by far the most common uropathogen, accounting for >80% of all cases. Other major clinical problems associated with UTI include asymptomatic bacteriuria, and patients with complicated UTI. Complicated UTIs are a heterogeneous group associated with conditions that increase the risk of acquiring infection or treatment failure. Distinguishing between complicated and uncomplicated UTI is important, as it influences the initial evaluation, choice, and duration of antimicrobial therapy. Diagnosis is especially challenging in the elderly and in patients with in-dwelling catheters. The increasing prevalence of resistant uropathogens, including extended-spectrum β-lactamases and carbapenemase-producing Enterobacteriaceae, and other multidrug-resistant Gram-negative organisms further compromises treatment of both complicated and uncomplicated UTIs. The aim of these Clinical Guidelines is to provide a set of recommendations for improving the diagnosis and treatment of UTI.

摘要

大多数尿路感染(UTI)是发生在年轻女性中的单纯性感染。大多数情况下不需要进行广泛评估,作为门诊患者使用口服抗生素即可安全治疗。到目前为止,大肠埃希菌是最常见的尿路病原体,占所有病例的80%以上。与UTI相关的其他主要临床问题包括无症状菌尿以及复杂性UTI患者。复杂性UTI是一组异质性疾病,与感染风险增加或治疗失败的情况相关。区分复杂性和非复杂性UTI很重要,因为这会影响抗菌治疗的初始评估、选择和疗程。在老年人和留置导尿管的患者中,诊断尤其具有挑战性。包括超广谱β-内酰胺酶和产碳青霉烯酶肠杆菌科细菌以及其他多重耐药革兰氏阴性菌在内的耐药尿路病原体的患病率不断上升,这进一步影响了复杂性和非复杂性UTI的治疗。这些临床指南的目的是提供一套改善UTI诊断和治疗的建议。

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