Urinary tract infection (UTI), referred to as urinary tract infection, is an infectious disease of the urinary tract caused by the growth and multiplication of various pathogenic microorganisms in the urinary tract. UTI is a urinary tract infection caused by the growth and multiplication of various pathogenic microorganisms in the urinary tract. The former refers to pyelonephritis. (The former refers to pyelonephritis, while the latter mainly refers to cystitis. Pyelonephritis and cystitis can be divided into acute and chronic.
According to the presence or absence of functional or structural abnormalities of the urinary tract, they can be divided into complex and uncomplicated urinary sensation. Complex urinary sensation is defined as a urinary tract infection accompanied by structural or functional abnormalities such as poor urinary drainage, stones, malformations, vesicoureteral reflux, or on the basis of chronic substantial renal disease. Those not associated with the above are called uncomplicated urinary tract infections.
(I) Diagnosis of urinary tract infection
Typical urinary tract infections have signs of urinary tract irritation, symptoms of infection toxicity, and lumbar discomfort, etc. The diagnosis is not difficult when combined with urine changes and urine bacteriological examination. Anyone with true bacteriuria can be diagnosed with urinary tract infection. The diagnosis of asymptomatic bacteriuria relies mainly on urine bacteriological examination, which requires two bacterial cultures of the same strain of true bacteriuria. When women have obvious urinary frequency, urinary urgency, urinary pain, urinary leukocytosis, quantitative urine bacterial culture ≥10↑2/ml, and common pathogenic bacteria, the diagnosis of urinary tract infection can be proposed.
(B) Localized diagnosis of urinary tract infection
The presence of true bacteriuria indicates the presence of urinary tract infection, but it cannot be judged as upper or lower urinary tract infection, and localization diagnosis is required.
1.Localization according to clinical manifestations Upper urinary tract infection often has fever, chills, and even symptoms of toxemia, accompanied by obvious back pain, pressure pain at ureteral points and/or cribriform points, and percussion pain in the kidney area. In contrast, lower urinary tract infection is often highlighted by bladder irritation signs, and generally less fever and lumbago.
2.Localization according to laboratory tests The presence of the following conditions suggests upper urinary tract infection.
(1) Positive urine culture after bladder irrigation;
(2) Urine sediment microscopy with leukocyte tubular pattern and exclusion of interstitial nephritis, lupus nephritis and other diseases;
(3) Elevated urinary NAG and elevated urinary β↓2-MG:
(4) Lower urinary osmolality.
3, the diagnosis of chronic pyelonephritis in addition to the history of recurrent urinary tract infections, but also need to be combined with imaging and renal function tests.
(1) Uneven kidney shape and unequal size of both kidneys;
(2) Intravenous pyelogram shows distortion and narrowing of the renal pelvis and calyces;
(3) persistent renal tubular impairment.
Chronic pyelonephritis can be diagnosed with any of the above (1) and (2) plus (3)
(C) Treatment of urinary tract infection
(1) General treatment
In the acute stage, pay attention to rest, drink more water and urinate regularly. In febrile cases, give an easy-to-digest, high-calorie, vitamin-rich diet. For obvious bladder irritation and hematuria, take 1g of sodium bicarbonate tablets orally three times a day to alkalize urine, relieve symptoms, inhibit bacterial growth, and avoid the formation of blood clots, and for those who apply sulfonamide antibiotics, enhance the antibacterial activity of the drugs and avoid the formation of urinary tract crystals. Recurrent urinary tract infections should be actively searched for the cause and the triggering factors should be removed in a timely manner.
(2) Anti-infection treatment
The principles of drug use.
① Use antibiotics that are sensitive to the causative organism. Before no pathogenic results, antibiotics that are effective against gram-negative bacilli are generally preferred, especially for the first urinary tract infection. Treatment for 3 days no improvement in symptoms, should be adjusted according to the drug sensitivity results of the medication.
②The concentration of antibiotic disorder in urine and kidney should be high.
③ Select antibiotics with less nephrotoxicity and less side effects.
④A combination of drugs should be used when single drug treatment fails, serious infection, mixed infection, and drug-resistant strains appear.
⑤ Give different treatment time for different types of urinary tract infections.
(iv) Prevention
Insist on drinking more water and urinating more often is the most effective prevention method; pay attention to perineal cleanliness; avoid the use of urinary tract instruments as much as possible, and when it is necessary to apply them, operate strictly aseptically.