Urinary tract infection, also known as UTI, or urinary tract infection for short, is caused byBacteria、mycoplasma、chlamydia、VirusesInfectious disease caused by the growth and reproduction of other pathogens in the urinary tract.Urinary tract infection can be divided into upper urinary tract infection and lower urinary tract infection. Upper urinary tract infection is mainlypyelonephritis、Ureteritis，Lower urinary tract infectionMainlycystitis、urethritis。The disease can be classified according to the presence or absence of symptoms and urinary tract abnormalities.Urinary tract infection is the second largest infectious disease after respiratory tract infection. The susceptible population is infants and the elderly, especially adult women. Women are 60% likely to suffer from urinary tract infection at least once in their lifetime.
The treatment of urinary tract infection mainly depends on antibiotics. For patients with primary infection, it is necessary to actively seek for causes, targeted treatment and timely removal of inducing factors.When some patients have recurrent attacks, they should actively look for the cause and remove the inducing factors in time.At the same time, patients should pay attention to rest and drink more water.
The key non-medical information related to urinary tract infection includes:antibioticandImmunosuppressantWide application of,Gram positive bacteriaAnd fungal urinary tract infections increased, drug resistance and even multi drug resistance increased.In addition, young men need to pay attention to distinguishing lower urinary tract symptoms caused by urinary tract infection and prostatitis, and middle-aged and old men need to pay attention to lower urinary tract symptoms caused by diseases such as urinary tract infection and prostatic hyperplasia.
TCM disease name
urinary tract infection
Foreign name
urinary tract infection
Alias
Urinary sensation, urinary tract infection
Visiting department
Urology, nephrology, gynecology
Multiple population
Infants and the elderly, adult women
Common causes
Infection, pathogens such as bacteria, mycoplasma, chlamydia, etc
Urinary tract infection is caused by some factors, which causes pathogens to invade the human body through ascending infection, blood line infection, direct infection and even lymphatic infection, and break through the body's defense to cause disease.
Pathogenesis
bacterial infection
Urinary tract infection is more than 95% caused by a single bacterium.The most common pathogenic bacteria are gram-negative bacilli, among whichEscherichia coliThe most common is about 85% of all urinary tract infections, followed by KlebsiellaProteus、CitrobacterEtc.Escherichia coli is most commonly found inAsymptomatic bacteriuriaNon complex urinary tract infection or the first occurrence of urinary tract infection.5%~15% of urinary tract infections are caused by gram-positive bacteria, mainlyenterococcusAnd coagulase negativestaphylococcus。
Nosocomial infection, complicated or recurrent urinary tract infection, and urinary tract infection after urinary instrument examination are mostlyenterococcus、ProteusKlebsiella and Pseudomonas aeruginosa.Proteus is commonly seen in patients with urinary calculi, Pseudomonas aeruginosa is commonly seen after urinary instrument examination, and Staphylococcus aureus is commonly seen in blood borne urinary tract infections.
Infection by other pathogens
Adenovirus can cause acute hemorrhagic cystitis in children and some young people, and even cause epidemics.In addition, mycobacterium tuberculosis, chlamydia, fungi, etc. can also lead to urinary tract infection.In recent years, due to the extensive application of antibiotics and immunosuppressants,Gram positive bacteriaAnd fungal urinary tract infections increased, drug resistance and even multi drug resistance increased.
Predisposing factors
Due to the anatomical and physiological characteristics of the urinary and reproductive systems, pathogenic bacteria are not easy to stay and reproduce under normal conditions, so they are not easy to cause infection.Once there are pathological changes in the urinary and reproductive systems, the function of defense against infection is destroyed, and pathogenic bacteria enter the country to induce infection.
Structural urinary tract obstruction
Any factors that hinder the free flow of urine, such asstone、Hyperplasia of prostate, narrowtumourHabitual suffocation can lead to the accumulation of urine. Bacteria are not easy to be washed away, but can multiply in local areas and cause infection.
The mucosa at the inner segment of the ureter wall and the opening of the bladder forms a barrier that prevents the urine from flowing back from the bladder ureter orifice to the ureter. When its function or structure is abnormal, the urine can flow back from the bladder to the ureter, or even the renal pelvis, leading to bacterial colonization and infection.
Nerve dysfunction that controls the bladder, such as spinal cord injury, diabetes, multiple sclerosis and other diseases, causes infection due to long-term urine retention and the use of urinary catheters to drain urine.
Urinary tract infection can occur in 2%~8% of pregnant women, which is related to the weakening of ureteral peristalsis during pregnancy, temporary bladder ureteral valve insufficiency, and obstructed urine drainage due to uterine enlargement in late pregnancy.
Low immunity
Such as long-term use of immunosuppressants, diabetes, AIDS or seriouschronic disease, long-term bed rest, etc.The immune function of this part of the population is damaged, which is easy to cause infection.
Abnormal structure of urinary system
Such as renal dysplasia, renal pelvis andUreteral malformation, transplanted kidneyPolycystic kidneyIt is the susceptible factor of urinary tract infection.
Characteristics of female physiological structure
The female urethra is short and wide, with the opening below the labia, close to the external opening of the vagina, and close to the anus, which is an important factor for women to be prone to urinary tract infection.
Male phimosis and redundant prepuce
Phimosis and redundant prepuce are the inducing factors of male urinary tract infection.
Sexual activities
The bacteria around the urethral orifice can be squeezed into the bladder during sexual lifeurinary tract infection。
Nonphenylpolyol, the main component of contraceptives, can destroy the normal vaginal microbial environment and increase the occurrence of bacterial urine.
Iatrogenic factor
Catheterization or indwelling catheter, cystoscopy and ureteroscopy, retrograde urography, etc. can cause damage to the urinary tract mucosa. If bacteria are introduced into the urethra, it is easy to cause urinary tract infection.
Genetic factor
More and more evidence shows that host genes affect the susceptibility to urinary tract infection.
symptom
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The clinical symptoms of patients with urinary tract infection areFrequency of urination、Urgency of urination、Urinalgia, evenGross hematuria、lumbagoSuch local symptoms as fever, chills and other systemic symptoms can also exist at the same time, and some patients have no obvious or asymptomatic clinical symptoms.
Patients with abnormal structure and function of the genitourinary tract or other primary diseases leading to infection may have various symptoms.Because there are many classifications of urinary tract infection, there are different symptoms under different classifications.Common types are as follows:
The main clinical manifestations are frequent urination, urgency of urination, pain in urination, discomfort in the suprapubic bladder region or perineum, and burning sensation of the urethra.
Cystitis can be further divided into acute simple cystitis and recurrent cystitis.
Patients with acute simple cystitis are often accompanied by urgent urinary incontinence, turbid urine, white blood cells in the urine, terminal hematuria, sometimes full course hematuria, and even blood clots.Generally, there are no systemic symptoms, normal body temperature or only low fever.
The main symptoms include frequent urination, urgency of urination, pain in urination, hematuria, dysuria, distention and pain in the affected side or both sides of the waist, and obvious tenderness or percussion pain in the costal and spinal angles.At the same time, it can be accompanied by chills, headache, nausea, high fever and other symptoms. The patient's temperature can rise to more than 39 ℃.
Systemic and local manifestations of urinary system may be atypical, sometimes only asymptomatic bacteriuria.More than half of the patients may have a history of acute pyelonephritis, followed by varying degrees of low fever, intermittent frequency of urination, discomfort in urination, waist pain, etc., and may have increased nocturia and other manifestations.It may develop into chronic renal failure in later stage.
The patient has no clinical symptoms and is only diagnosed by microbiology. There is no obvious abnormality or increase of white blood cells in routine urine test, but there are bacteria in urine culture.
Because such patients with urinary tract infection are accompanied by urinary tract abnormalities or immunosuppression, their clinical manifestations vary greatly.There are not only mild urinary system symptoms, but also cystitis, pyelonephritis symptoms, and even more serious patients can have bacteremia, sepsis.
Medical treatment
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When the patient suddenly has symptoms such as frequent urination, urgency of urination, pain in urination, low back pain, fever or any other symptoms for the first time, it is recommended to seek medical advice in time.The doctor will make a comprehensive judgment based on the patient's medical history, symptoms, signs, laboratory examination and imaging examination results.
Visiting department
Patients with urinary tract infection should give priority to urology department, or nephrology department, and women can choose gynecology department.
Relevant inspection
signs and symptoms
The common symptoms of lower urinary tract infection are frequent urination, urgency of urination, pain in urination, etc., while the upper urinary tract infection is more common in renal pain and fever.
About 1/3 of the patients with only cystitis symptoms will be found to have upper urinary tract infection at the same time after further examination.
The urine is often turbid, and may have odor, white blood cell urine, hematuria, and proteinuria.Urine sediment microscopic examination of leucocyte>5/HP is leucocytic urine. Because this result can be seen in most patients with urinary tract infection, this examination result is very significant for the diagnosis of urinary tract infection.
Urine bacterial culture
The culture of mid section urine sample before treatment is the most reliable indicator for the diagnosis of urinary tract infection.Number of bacterial colonies ≥ 10fiveCFU/ml (CFU: colony forming unit, indicating the amount of bacteria in urine) is meaningful bacteriuria.If the patient's examination result is positive, but there is no obvious symptom, the doctor may suggest to do two cultures for further evidence.
Positive results are found in urinary tract infections caused by gram negative bacteria such as Escherichia coli. This test has strong specificity for the diagnosis of urinary tract infections, but has poor sensitivity. It can be used as a screening test for urinary tract infections.
Leukocyte esterase test
It is negative under normal circumstances and positive under urinary tract infection.
When the renal function of chronic pyelonephritis is damaged, abnormal changes such as decreased glomerular filtration rate and elevated serum creatinine may occur.
Imaging examination
Imaging examination should be considered for patients with recurrent urinary tract infection, recurrent pyelonephritis, painless hematuria, or suspected urinary calculi or obstruction.
Urinary system ultrasound is the first choice, because it is simple and non-invasive, and can find the combined urinary tract obstruction, pus, stones and other diseases.
UrogramUpper urinary calculi and malformations can be found by intravenous urography.
Computed tomography (CT) of urinary system is an effective examination to further clarify the lesions.
Women with symptoms of urinary tract infection should consider whether there is vaginitis, genital ulcer or gonorrhea.Gynecological examination can make it clear that if patients have vaginal secretions or vulval inflammation, they can often be identified, and pelvic double diagnosis can identify pelvic masses and pelvic inflammation.
Urinary system specific infection
Patients with lower urinary tract symptoms such as urgency of urination, frequency of urination, pain of urination and pyuria, but patients with negative urine culture should consider whether there is gonococcal infection or ureaplasma urealyticum infection.Urinary tract infection that fails to respond to general antimicrobial treatment should be checked for urinary tuberculosis.
Female patients with lower urinary tract symptoms but no evidence of infection should be differentiated from other diseases that cause lower urinary tract symptoms, such as overactivity of the bladder.
Urinary tract infection in young men
Young men should be differentiated from lower urinary tract symptoms caused by prostatitis, and middle-aged and elderly men should be differentiated from lower urinary tract symptoms caused by diseases such as prostatic hyperplasia.
Patients with bladder irritation syndrome who lack sufficient evidence of infection should exclude the presence of bladder carcinoma in situ, and cystoscopy and multi-point biopsy should be performed to prevent missed diagnosis.
treatment
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The treatment of urinary tract infection is mainly to pay attention to rest, drink more water, and apply antibiotics sensitive to pathogenic bacteria in sufficient quantity and in full course of treatment for anti infection treatment.If the urinary tract infection occurs repeatedly, we should actively seek for the cause, targeted treatment, and timely remove the inducing factors.
The following criteria are used to evaluate the treatment of urinary tract infection:
Cure: symptoms disappear, urine bacteria are negative, and urine bacteria are still negative after 2 and 6 weeks of treatment.
Treatment failure: the urine bacteria is still positive after treatment, or the urine bacteria is negative after treatment, but the urine bacteria turns positive 2 weeks or 6 weeks after the end of the treatment, and it is the same strain.
Acute treatment
Patients in acute stage should pay attention to rest, drink more water and urinate frequently;Those with fever should be given a diet that is easy to digest, high in calories and rich in vitamins.Actively carry out anti infection treatment, and the principles of selecting antibiotics are as follows:
Select antibiotics sensitive to pathogenic bacteria;
The concentration of antibiotics in urine and kidney is higher;
Antibiotics with less nephrotoxicity and adverse reactions were selected;
When single drug treatment fails, serious infection, mixed infection, and drug-resistant strains appear, they should be combined with drugs;
Different types of urinary tract infection have different treatment duration.
General treatment
Those with obvious bladder irritation and hematuria can take 1g of sodium bicarbonate tablet orally three times a day to alkalize urine, relieve symptoms, inhibit bacterial growth, and avoid blood clots. For those who apply sulfonamide antibiotics, it can also enhance the antibacterial activity of drugs and avoid the formation of urinary tract crystals.
Recurrent urinary tract infection should be actively looking for the cause of disease and timely removal of predisposing factors.
medication
Treatment of acute simple cystitis in premenopausal non pregnant women
Short course antimicrobial therapy
Fosfomycin, furantoin, quinolones (such as norfloxacin, ofloxacin, ciprofloxacin, fleroxacin, etc.), and second-generation cephalosporins (such as cefaclor, cefnicide, cefprozil, cefuroxime, etc.) can be used for 3 to 7 days.
Most patients with acute simple cystitis can turn negative after single dose therapy or 3-day therapy.The use of moxifloxacin is not recommended for quinolones because it cannot reach an effective concentration in urine.
Symptomatic treatment
During treatment, drink more water, take sodium bicarbonate or potassium citrate to alkalize urine, and use xanthopteride hydrochloride or anticholinergic drugs when necessary to alleviate bladder spasm and bladder irritation.In addition, hot compress in bladder area and hot water hip bath can also reduce bladder spasm.
Treatment of acute simple cystitis in postmenopausal women
The treatment plan is the same as that of acute simple cystitis in premenopausal non pregnant women.Estrogen replacement therapy can restore the atrophic mucosa of the urogenital tract in postmenopausal women, increase the number of lactobacilli in the vagina, and reduce the vaginal pH value, which is conducive to preventing recurrence of urinary tract infection.
Treatment of acute simple pyelonephritis in non pregnant women
Antibacterial drugs with high concentration in urine and blood should be selected.For mild and moderate patients, it can be administered orally.For severe patients, the drug should be given by injection first, and after the disease is relieved, it can be transferred to oral sensitive antimicrobial treatment for 1-2 weeks.
Mild patients can use quinolones for 7-10 days as the first-line treatment plan.If the treatment is effective, continue to use.If no effect is found 48~72 hours after the drug is used, effective drug treatment should be selected according to the drug sensitivity test.
Follow up and recheck should be carried out after treatment. If bacteriuria still exists after 14 days of medication, the drug should be changed according to the drug sensitivity test, and the treatment should be continued for 6 weeks.
For those with fever over 38.5 ℃, low back pain, elevated white blood cells, or serious systemic poisoning symptoms, and suspected bacteremia, they should first be given intravenously. After 72 hours of fever relief, they should be changed to oral antibiotics, including quinolones, second-generation cephalosporins or third-generation cephalosporins (such as cefotaxime, ceftriaxone, ceftazidime, cefoperazone, etc.)Complete 2 weeks of treatment.
Treatment of urinary tract infection during pregnancy
Asymptomatic bacteriuria
The American Association of Infectious Diseases recommends that urine culture examination be carried out in the early pregnancy. If the result is positive, treatment should be carried out in time. Antibacterial treatment should be given for 5 to 7 days according to the drug sensitivity test results. Urine culture examination should be carried out again 1 to 4 weeks after treatment to evaluate the treatment effect.
Acute cystitis
According to the results of urine culture and drug sensitivity test, 7 days of antibiotic treatment can be given. If it is too late to wait for the results of drug sensitivity test, the second generation cephalosporin, the third generation cephalosporin, amoxicillin, furantoin or fosfomycin can be given.After one week of treatment, urine culture should be performed again to understand the treatment effect.
Acute pyelonephritis
It is recommended to give intravenous infusion treatment of antibiotics first according to the results of urine culture or blood culture and drug sensitivity test. If it is too late to wait for the results of drug sensitivity test, the second generation cephalosporin or the third generation cephalosporin, or aminopenicillin plus β - lactamase inhibitor (such as clavulanic acid, sulbactam, tazobactam, etc.) can be selected for treatment.After symptoms improve, continue to take antibiotics orally for at least 14 days.
Precautions for the use of antibiotics in pregnant women
Drugs with teratogenic or obvious toxic effects on the fetus
For example, aminoglycosides (such as streptomycin, gentamicin, tobramycin, amikacin, netilmicin, etc.), vancomycin, etc. should also be avoided during pregnancy.
It is recommended to select drugs with low toxicity, no obvious impact on fetus and mother, and no teratogenic effect
Such as penicillin (such as penicillin V, methicillin, ampicillin, amoxicillin, etc.), cephalosporins (such as cefalexin, cefradine, ceftriaxone, cefaclor, etc.), beta lactams and fosfomycin, etc.
Treatment of recurrent urinary tract infection
Reinfection
It indicates that the ability of urinary tract to prevent infection is poor, not because of treatment failure. If necessary, low-dose long-term bacteriostatic therapy can be applied to such cases, that is, take low-dose antibiotics once every night before going to bed and after urination, such as 1-2 compound sulfamethoxazole tablets, orFurantoin50-100 mg, orOfloxacin200 mg, change the drug every 7-10 days for six months.
recrudescence
Sensitive antibiotics should be selected according to the results of drug sensitivity test, and the maximum allowable dose should be used for 6 weeks. If it does not work, it can be considered to extend the course of treatment or use injection instead.
Complex urinary tract infection
The treatment of complex urinary tract infections depends on the severity of the disease.If the condition is serious, hospitalization is required.In addition to antibiotic treatment, it is also necessary to correct the anatomical or functional abnormalities of the urinary system and treat other potential diseases, and if necessary, nutritional support treatment.
Catheter related urinary tract infection
Conduit treatment
If it is unnecessary to continue to detain the catheter, it shall not be intubated.If it is necessary to continue to use catheter drainage, a new catheter can be replaced or other methods can be used.
Selection of antimicrobial agents
Urine culture was performed before treatment.Patients with mild symptoms can choose oral medication. Patients with severe illness and fever, especially those with positive blood culture, should use infusion treatment, usually using broad-spectrum antibiotics.
When the urine culture result is obtained, it should be adjusted according to the drug sensitivity test.The treatment situation should be evaluated 48~72 hours after taking the medicine. If the symptoms of the patient disappear quickly, it usually only needs 5~7 days of treatment;Patients with severe symptoms usually need treatment for 10-14 days.
Antifungal treatment can be used when candida infection occurs occasionally.Long term and unwarranted use of antibiotics is not recommended.
surgical treatment
For patients with urinary tract infection caused by urinary tract malformations, urinary tract stones, tumors, benign prostatic hyperplasia, redundant prepuce and phimosis, surgical treatment must be performed to remove the cause after infection control.
TCM treatment
Urinary tract infection belongs to "gonorrhea", "low back pain" and other categories in traditional Chinese medicine. Its main pathogenesis is kidney deficiency, damp heat block, and unfavorable gasification of kidney and bladder;Kidney deficiency is the foundation, and damp heat block is the standard.Its treatment in traditional Chinese medicine mainly includes traditional Chinese medicine, acupuncture, Chinese patent medicine, etc.
Traditional Chinese Medicine Prescriptions
It is mainly divided into three syndrome types, and the prescription and medication are selected under the guidance of holistic view and syndrome differentiation and treatment.
Damp heat syndrome of bladderIt is suitable to clear away heat and dampness, diuresis and pass the shower, and use Bazheng Powder and Simiao Powder to add and subtract.
The syndrome of kidney deficiency and liver stagnation, and retention of damp and heat, should be treated by purging the liver and nourishing yin, diuresis and purging gonorrhea, and the combination of Longdan Xiegan Decoction and Liuwei Dihuang Decoction should be used.
Qi and yin injury, damp heat and blood stasis syndrome should be treated by supplementing qi and yin, clearing heat and removing dampness, promoting blood circulation and removing dampness.
Acupuncture and moxibustion treatment
Acupuncture treatment mainly includes simple acupuncture treatment, moxibustion treatment, combination of acupuncture and moxibustion, combination of acupuncture and medicine, acupuncture and moxibustion combined with traditional Chinese medicine sitz bath, moxibustion combined with antibiotics, moxibustion combined with traditional Chinese medicine, etc.
Acupuncture and moxibustion in traditional Chinese medicine can regulate the immune function of the body, regulate the function of bladder and urethra through acupoints, nerves and meridians, improve the urination discomfort of patients with urinary tract infection, alleviate symptoms, alleviate patients' pain, and reduce the recurrence rate.
Chinese patent medicine treatment
At present, many Chinese patent medicines can be used to treat urinary tract infections. For example, Sanjin Tablet has the effects of clearing away heat and toxic substances, promoting diuresis and removing gonorrhea, and tonifying the kidney. It is mainly used to treat the gonorrhea caused by the damp heat of lower energizerUrine is short and red, dripping pain, urgency of urination;Qinglin Granule has the effects of clearing away heat, purging fire, promoting water and relieving gonorrhea. It is mainly used to treat gonorrhea caused by damp heat in the bladder, as well as the symptoms such as frequent urination, astringent pain, poor drainage, fullness of the lower abdomen, dry mouth and dry throat.
Traditional Chinese medicine has a long history of treating urinary tract infection and has significant curative effect. It has unique advantages in reducing a series of adverse reactions caused by western medicine treatment, improving the quality of life of patients, controlling disease progress, and reducing recurrence rate.However, there are also shortcomings that need to be treated objectively and actively integrated with modern medicine to seek more effective treatment methods.
prognosis
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After antibiotic treatment, 90% of uncomplicated acute urinary tract infections can be cured, and about 10% can turn into persistent bacteriuria or recurrent attacks.
The clinical cure rate of complicated urinary tract infection is low, and it is easy to relapse. Unless the abnormalities of urinary tract anatomy or function are corrected, it is extremely difficult to cure. More than half of the patients suffer from persistent bacterial urine or recurrent urinary tract infections.Therefore, if urinary tract infection occurs, regular treatment should be actively carried out.
complication
If urinary tract infection can be treated in time, there will be few complications, but pyelonephritis with diabetes and complicated factors can cause serious complications if not treated in time or treated improperly.
It is often directly expanded from severe pyelonephritis. Most pathogenic bacteria are Gram negative bacilli, and Escherichia coli is the most common.Most patients have predisposing factors such as diabetes and urinary calculi.
pyelonephritisComplicated with infectious nephrolithiasis
Pyelonephritis caused by proteus and other urea decomposing bacteria can often cause kidney stones, known as infectious kidney stones.
Urinary tract infection is one of the main causes of gram-negative bacilli septicemia. It often occurs in acute symptomatic urinary tract infection, especially after cystoscopy or use of urinary catheter, long-term indwelling of urinary catheter is more likely to occur.
