尿路感染中大课件.ppt

1、*中山一院 30196普查女性结果CASE 1 A 32 year-old woman complains of dysuria and frequency;pyuria is seen in the urine sediment.Gram stain of unspun urine(x1000)shows an inflammatory cell and numerous Gram negative bacilli.Escherichia coli grew from this specimen.CASE 2 A 65 year-old woman complains of dysuria

2、and frequency;pyuria is seen in the urine sediment.Gram stain of unspun urine(x1000)shows inflammatory cells and Gram positive cocci in chains.Enterococcus faecalis grew from this specimen.CASE 3 An 18 year-old woman complains of dysuria and frequency;pyuria is seen in the urine sediment.Gram stain

3、of unspun urine(x1000)shows inflammatory cells and Gram positive cocci in pairs and clusters.Staphylococcus saprophyticus(腐生)grew from this specimen.CASE 4 This specimen was obtained from a 42 year-old diabetic woman with a Foley catheter.Gram stain of unspun urine(x1000)shows Gram positive budding

4、yeasts and large pseudohyphae.Candida albicans grew from this specimen.Escherichia coli grew from this specimen.105/m1，且为同一菌种（株）。Gram stain of unspun urine(x1000)shows inflammatory cells and Gram positive cocci in chains.病情允许，尽快查有无尿路复杂因素，并及时解除。单剂量的抗生素治疗应避免，至少7天目前定位诊断最有价值的方法复发性尿路感染约80%是重新感染。Staphyloc

5、occus saprophyticus(腐生)grew from this specimen.如在治疗14天后仍有菌尿，则可参考药敏试验改用有效药物，再用药6周。影像学检查:发现皮质瘢痕及肾盂肾盏变形或不对称不管有否症状，妊娠期尿感均应治疗。有无 治疗原则治疗原则 疗效评定标准疗效评定标准Drug,dose Dose and interval DurationLevofloxacin 250 mg q 24 hours 3 daysCiprofloxacin 100 to 250 mg q 12 hours 3 days or 500 mg q 24 hours 3 daysTrimethop

6、rim-160/800 mg q 12 hours 3 daysSulfamethoxazoleTrimethoprim 100 mg q 12 hours 3 daysCefpodoxime proxetil（头孢泊肟酯）100 mg q 12 hours 3-7 daysNitrofurantoin macrocystals 50 mg q 6 hours 7 daysNitrofurantoin monohydrate 100 mg q 12 hours 7 days macrocystals(Macrobid)Amoxicillin/clavulanate 500 mg q 12 ho

7、urs 7 daysSelected oral antimicrobial regimens for use in acute uncomplicated cystitis 耐药性问题！1 慢性膀胱刺激症，经抗生素治疗无效，必须使用无菌的、密闭的引流系统，避免开放；贮尿袋需置于膀胱水平以下，保证向下通畅地尿流，并定期放空尿袋；厌氧菌、衣原体或真菌等其他微急性女性非复杂性肾盂肾炎必须指出，有明显急性膀胱刺激症的妇女，尿中有较多白细胞，如中段尿含菌数102个/ml，亦可疑诊为尿感。104/ml 污染假阴性:7天内用过抗生素敏感性约为70.复方新诺明（含SMZ400g，TMP80mg）顿服6片、甲氧苄啶（TMP）0.焦虑性精神状态有关肾脏缩小如在治疗14天后仍有菌尿，则可参考药敏试验改用有效药物，再用药6周。尿培养结果若为阳性，且为同样细菌，为尿感复发，可诊为隐匿性肾盂肾炎。敏感性约为70.急性女性非复杂肾盂肾炎Aztreonam,1 g Q8-12 hours在无药敏试验结果时，应选用对革兰氏阴性杆菌有效的抗菌药物，如有效则不必改药。治疗有效治疗有效常再发者