Froom J
J Fam Pract. 1980 Sep;11(3):385-91.
Urinary tract infections are among the most frequently encountered health problems in patients of family physicians. The diagnosis requires the demonstration of more than 100,000 bacterial colonies per milliliter in a freshly voided urine specimen. Dysuria, proteinuria, and pyuria are unreliable diagnostic criteria. The pathogenesis is uncertain although vaginal colonization with enteric bacteria, voluntary avoidance of urination, and sexual intercourse are contributing causes. Vesicoureteral reflux is related to recurrent infection but a causal relationship has not been established. Urinary tract infection in children is related to decreased renal growth and kidney scars, but therapy of the infections does not prevent kidney damage. Infections disappear spontaneously in up to 40 percent of adult women. Bacteriuria in pregnancy, however, is related to low birth weight in infants and increased perinatal mortality. Asymptomatic bacteriuria need not be diagnosed or treated except in pregnant women. For symptomatic infections, short-term antibiotic therapy is as effective as long-term therapy. Prophylactic antibiotics and therapy by modification of behavior using a multifaceted regimen can reduce the frequency of recurrent infection.
尿路感染是家庭医生接诊患者时最常遇到的健康问题之一。诊断需要在新鲜排出的尿液标本中每毫升发现超过10万个细菌菌落。排尿困难、蛋白尿和脓尿是不可靠的诊断标准。尽管肠道细菌在阴道定植、刻意憋尿和性交是促成因素，但发病机制尚不清楚。膀胱输尿管反流与反复感染有关，但因果关系尚未确立。儿童尿路感染与肾脏生长减缓及肾瘢痕有关，但感染的治疗并不能预防肾损伤。高达40%的成年女性感染会自行消失。然而，孕期菌尿与婴儿低出生体重及围产期死亡率增加有关。除孕妇外，无症状菌尿无需诊断或治疗。对于有症状的感染，短期抗生素治疗与长期治疗效果相同。预防性使用抗生素以及采用多方面方案通过改变行为进行治疗可降低反复感染的发生率。
