Department of Medicine, University of Miami Miller School of Medicine, Miami, FL 33136.
Microbiol Spectr. 2016 Dec;4(6). doi: 10.1128/microbiolspec.UTI-0021-2015.
UTI may involve the lower or upper urinary tract and may be uncomplicated or complicated. The emphasis of this chapter is uncomplicated UTI. The diagnosis of uncomplicated cystitis (bladder infection) and pyelonephritis (kidney infection) is usually easily made based on the clinical presentation, whereas the diagnosis in patients with complicated UTI is often more complex. Thus uncomplicated cystitis is usually manifested by dysuria, frequency and/or urgency without fever, and pyelonephritis is usually manifested by fever and back pain/costovertebral angle tenderness. However, pyuria is usually present with UTI, regardless of location, and its absence suggests that another condition may be causing the patient's symptoms. Treatment of cystitis is usually straightforward with one of several effective short-course antimicrobial regimens, although antimicrobial resistance continues to increase and can complicate treatment choices in certain areas. Likewise, antimicrobial resistance has complicated our management of uncomplicated pyelonephritis since resistance of uropathogens to the fluoroquinolone class, the mainstay of oral treatment for pyelonephritis, is increasing worldwide, and some of the other agents used for cystitis are not recommended for pyelonephritis due to low tissue levels. The goal of prevention of recurrent cystitis is to minimize the use of antimicrobials and there are several research efforts in progress to develop effective and safe antimicrobial-sparing preventive approaches for this common condition.
尿路感染可涉及下尿路或上尿路，可简单或复杂。本章重点介绍简单尿路感染。简单膀胱炎（膀胱感染）和肾盂肾炎（肾脏感染）的诊断通常基于临床表现很容易做出，而复杂尿路感染患者的诊断通常更为复杂。因此，简单膀胱炎通常表现为尿痛、尿频和/或尿急，无发热，而肾盂肾炎通常表现为发热和腰痛/肋脊角压痛。然而，尿路感染通常伴有脓尿，无论感染部位如何，其缺乏表明可能存在其他疾病导致患者出现症状。膀胱炎的治疗通常很简单，有几种有效的短期抗菌方案可供选择，尽管抗菌药物耐药性持续增加，并且在某些地区可能会使治疗选择复杂化。同样，尿路感染病原体对氟喹诺酮类药物的耐药性（肾盂肾炎口服治疗的主要药物）在全球范围内不断增加，也使我们对简单肾盂肾炎的管理变得复杂，因为一些用于膀胱炎的其他药物由于组织水平低而不推荐用于肾盂肾炎。预防复发性膀胱炎的目标是尽量减少抗菌药物的使用，目前正在进行多项研究工作，以开发针对这种常见疾病的有效且安全的抗菌药物保留预防方法。
