urinary tract infections

尿路感染症 UTIs

WordNet

1. (medicine) the invasion of the body by pathogenic microorganisms and their multiplication which can lead to tissue damage and disease
2. (phonetics) the alteration of a speech sound under the influence of a neighboring sound
3. the pathological state resulting from the invasion of the body by pathogenic microorganisms
4. (international law) illegality that taints or contaminates a ship or cargo rendering it liable to seizure
5. moral corruption or contamination; "ambitious men are led astray by an infection that is almost unavoidable"
6. an incident in which an infectious disease is transmitted (同)contagion, transmission
7. a brief treatise on a subject of interest; published in the form of a booklet (同)pamphlet
8. an extended area of land (同)piece of land, piece of ground, parcel of land, parcel
9. a system of body parts that together serve some particular purpose
10. a drawing created by superimposing a semitransparent sheet of paper on the original image and copying on it the lines of the original image (同)trace
11. the act of drawing a plan or diagram or outline
12. the discovery and description of the course of development of something; "the tracing of genealogies"
13. of or relating to the urinary system of the body
14. of or relating to the function or production or secretion of urine

PrepTutorEJDIC

1. 〈U〉(病気の)伝染;感染 / 〈C〉伝染病
2. 広大な土地(地域),(土地・海・空などの)広がり《+of+名》 / (器官の)管,(神経の)索
3. (おもに宗教・政治などの宣伝用の)小冊子,パンフレット
4. 跡を追うこと,追跡;透写,複写 / 〈C〉 / 透写(複写)によってできたもの(地図・図案など),透写図
5. 尿の;泌尿(ひにょう)[器]の

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/04/17 04:41:49」(JST)

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[Wiki en表示]

Urinary tract infection
Multiple white cells seen in the urine of a person with a urinary tract infection via microscopy
Classification and external resources
ICD-10	N39.0
ICD-9	599.0
DiseasesDB	13657
MedlinePlus	000521
eMedicine	emerg/625 emerg/626
Patient UK	Urinary tract infection
MeSH	D014552

A urinary tract infection (UTI) (also known as acute cystitis or bladder infection) is an infection that affects part of the urinary tract. When it affects the lower urinary tract it is known as a simple cystitis (a bladder infection) and when it affects the upper urinary tract it is known as pyelonephritis (a kidney infection). Symptoms from a lower urinary tract include painful urination and either frequent urination or urge to urinate (or both); while the symptoms of pyelonephritis include fever and flank pain in addition to the symptoms of a lower UTI. In some cases, a painful burning sensation in the urethra may be present even when not urinating. In the elderly and the very young, symptoms may be vague or non-specific. The main causal agent of both types is Escherichia coli, though other bacteria, viruses or fungi may rarely be the cause.

Urinary tract infections occur more commonly in women than men, with half of women having at least one infection at some point in their lives. Recurrences are common. Risk factors include female anatomy, sexual intercourse and family history. Pyelonephritis, if it occurs, usually follows a bladder infection but may also result from a blood-borne infection. Diagnosis in young healthy women can be based on symptoms alone. In those with vague symptoms, diagnosis can be difficult because bacteria may be present without there being an infection. In complicated cases or if treatment has failed, a urine culture may be useful. In those with frequent infections, low dose antibiotics may be taken as a preventative measure.

In uncomplicated cases, urinary tract infections are easily treated with a short course of antibiotics, although resistance to many of the antibiotics used to treat this condition is increasing. In complicated cases, a longer course or intravenous antibiotics may be needed, and if symptoms have not improved in two or three days, further diagnostic testing is needed. In women, urinary tract infections are the most common form of bacterial infection with 10% developing urinary tract infections yearly. In those who have bacteria or white blood cells in their urine but have no symptoms, antibiotics are generally not needed, although pregnant woman are an exception to this recommendation.

Signs and symptoms

Urine may contain pus (a condition known as pyuria) as seen from a person with sepsis due to a urinary tract infection.

Lower urinary tract infection is also referred to as a bladder infection. The most common symptoms are burning with urination and having to urinate frequently (or an urge to urinate) in the absence of vaginal discharge and significant pain. These symptoms may vary from mild to severe and in healthy women last an average of six days. Some pain above the pubic bone or in the lower back may be present. People experiencing an upper urinary tract infection, or pyelonephritis, may experience flank pain, fever, or nausea and vomiting in addition to the classic symptoms of a lower urinary tract infection. Rarely the urine may appear bloody or contain visible pus in the urine.

Children

In young children, the only symptom of a urinary tract infection (UTI) may be a fever. Because of the lack of more obvious symptoms, when females under the age of two or uncircumcised males less than a year exhibit a fever, a culture of the urine is recommended by many medical associations. Infants may feed poorly, vomit, sleep more, or show signs of jaundice. In older children, new onset urinary incontinence (loss of bladder control) may occur.

Elderly

Urinary tract symptoms are frequently lacking in the elderly. The presentations may be vague with incontinence, a change in mental status, or fatigue as the only symptoms, while some present to a health care provider with sepsis, an infection of the blood, as the first symptoms. Diagnosis can be complicated by the fact that many elderly people have preexisting incontinence or dementia.

Cause

E. coli is the cause of 80–85% of community-acquired urinary tract infections, with Staphylococcus saprophyticus being the cause in 5–10%. Rarely they may be due to viral or fungal infections. Healthcare-associated urinary tract infections (mostly related to urinary catheterization) involve a much broader range of pathogens including: E. coli (27%), Klebsiella (11%), Pseudomonas (11%), the fungal pathogen Candida albicans (9%), and Enterococcus (7%) among others. Urinary tract infections due to Staphylococcus aureus typically occur secondary to blood-borne infections. Chlamydia trachomatis and Mycoplasma genitalium can infect the urethra but not the bladder. These infections are usually classified as a urethritis rather than urinary tract infection.

Sex

In young sexually active women, sexual activity is the cause of 75–90% of bladder infections, with the risk of infection related to the frequency of sex. The term "honeymoon cystitis" has been applied to this phenomenon of frequent UTIs during early marriage. In post-menopausal women, sexual activity does not affect the risk of developing a UTI. Spermicide use, independent of sexual frequency, increases the risk of UTIs. Diaphragm use is also associated. Condom use without spermicide or use of birth control pills does not increase the risk of uncomplicated urinary tract infection.

Women are more prone to UTIs than men because, in females, the urethra is much shorter and closer to the anus. As a woman's estrogen levels decrease with menopause, her risk of urinary tract infections increases due to the loss of protective vaginal flora. Additionally, vaginal atrophy that can sometimes occur after menopause is associated with recurrent urinary tract infections.

Chronic prostatitis may cause recurrent urinary tract infections in males. Risk of infections increases as males age. While bacteria is commonly present in the urine of older males this does not appear to affect the risk of urinary tract infections.

Urinary catheters

Urinary catheterization increases the risk for urinary tract infections. The risk of bacteriuria (bacteria in the urine) is between three to six percent per day and prophylactic antibiotics are not effective in decreasing symptomatic infections. The risk of an associated infection can be decreased by catheterizing only when necessary, using aseptic technique for insertion, and maintaining unobstructed closed drainage of the catheter.

Male scuba divers utilizing condom catheters or the female divers utilizing external catching device for their dry suits are also susceptible to urinary tract infections.

Others

A predisposition for bladder infections may run in families. Other risk factors include diabetes, being uncircumcised, and having a large prostate. Complicating factors are rather vague and include predisposing anatomic, functional, or metabolic abnormalities. In children UTIs are associated with vesicoureteral reflux (an abnormal movement of urine from the bladder into ureters or kidneys) and constipation.

Persons with spinal cord injury are at increased risk for urinary tract infection in part because of chronic use of catheter, and in part because of voiding dysfunction. It is the most common cause of infection in this population, as well as the most common cause of hospitalization. Additionally, use of cranberry juice or cranberry supplement appears to be ineffective in prevention and treatment in this population.

Pathogenesis

The bacteria that cause urinary tract infections typically enter the bladder via the urethra. However, infection may also occur via the blood or lymph. It is believed that the bacteria are usually transmitted to the urethra from the bowel, with females at greater risk due to their anatomy. After gaining entry to the bladder, E. Coli are able to attach to the bladder wall and form a biofilm that resists the body's immune response.

Diagnosis

Multiple bacilli (rod-shaped bacteria, here shown as black and bean-shaped) shown between white blood cells in urinary microscopy. These changes are indicative of a urinary tract infection.

In straightforward cases, a diagnosis may be made and treatment given based on symptoms alone without further laboratory confirmation. In complicated or questionable cases, it may be useful to confirm the diagnosis via urinalysis, looking for the presence of urinary nitrites, white blood cells (leukocytes), or leukocyte esterase. Another test, urine microscopy, looks for the presence of red blood cells, white blood cells, or bacteria. Urine culture is deemed positive if it shows a bacterial colony count of greater than or equal to 10³ colony-forming units per mL of a typical urinary tract organism. Antibiotic sensitivity can also be tested with these cultures, making them useful in the selection of antibiotic treatment. However, women with negative cultures may still improve with antibiotic treatment. As symptoms can be vague and without reliable tests for urinary tract infections, diagnosis can be difficult in the elderly.

Classification

A urinary tract infection may involve only the lower urinary tract, in which case it is known as a bladder infection. Alternatively, it may involve the upper urinary tract, in which case it is known as pyelonephritis. If the urine contains significant bacteria but there are no symptoms, the condition is known as asymptomatic bacteriuria. If a urinary tract infection involves the upper tract, and the person has diabetes mellitus, is pregnant, is male, or immunocompromised, it is considered complicated. Otherwise if a woman is healthy and premenopausal it is considered uncomplicated. In children when a urinary tract infection is associated with a fever, it is deemed to be an upper urinary tract infection.

Children

To make the diagnosis of a urinary tract infection in children, a positive urinary culture is required. Contamination poses a frequent challenge depending on the method of collection used, thus a cutoff of 10⁵ CFU/mL is used for a "clean-catch" mid stream sample, 10⁴ CFU/mL is used for catheter-obtained specimens, and 10² CFU/mL is used for suprapubic aspirations (a sample drawn directly from the bladder with a needle). The use of "urine bags" to collect samples is discouraged by the World Health Organization due to the high rate of contamination when cultured, and catheterization is preferred in those not toilet trained. Some, such as the American Academy of Pediatrics recommends renal ultrasound and voiding cystourethrogram (watching a person's urethra and urinary bladder with real time x-rays while they urinate) in all children less than two years old who have had a urinary tract infection. However, because there is a lack of effective treatment if problems are found, others such as the National Institute for Health and Care Excellence only recommends routine imaging in those less than six months old or who have unusual findings.

Differential diagnosis

In women with cervicitis (inflammation of the cervix) or vaginitis (inflammation of the vagina) and in young men with UTI symptoms, a Chlamydia trachomatis or Neisseria gonorrheae infection may be the cause. These infections are typically classified as a urethritis rather than a urinary tract infection. Vaginitis may also be due to a yeast infection. Interstitial cystitis (chronic pain in the bladder) may be considered for people who experience multiple episodes of UTI symptoms but urine cultures remain negative and not improved with antibiotics. Prostatitis (inflammation of the prostate) may also be considered in the differential diagnosis.

Hemorrhagic cystitis, characterized by blood in the urine, can occur secondary to a number of causes including: infections, radiation therapy, underlying cancer, medications and toxins. Medications that commonly cause this problem include the chemotherapeutic agent cyclophosphamide with rates of 2 to 40%. Eosinophilic cystitis is a rare condition where eosinophiles are present in the bladder wall. Signs and symptoms are similar to a bladder infection. Its cause is not entirely clear; however, it may be linked to food allergies, infections, and medications among others.

Prevention

A number of measures have not been confirmed to affect UTI frequency including: urinating immediately after intercourse, the type of underwear used, personal hygiene methods used after urinating or defecating, or whether a person typically bathes or showers. There is similarly a lack of evidence surrounding the effect of holding one's urine, tampon use, and douching. In those with frequent urinary tract infections who use spermicide or a diaphragm as a method of contraception, they are advised to use alternative methods. In those with benign prostatic hyperplasia urinating in a sitting position appears to improve bladder emptying which might decrease urinary tract infections in this group.

Using urinary catheters as little and as short of time as possible and appropriate care of the catheter when used prevents infections. They should be inserted using sterile technique in hospital however non-sterile technique may be appropriate in those who self catheterize. The urinary catheter set up should also be kept sealed. Evidence does not support an important decreased in risk when silver-alloy catheters are used.

Medications

For those with recurrent infections, taking a short course of antibiotics when each infection occurs is associated with the lowest antibiotic use. A prolonged course of daily antibiotics is also effective. Medications frequently used include nitrofurantoin and trimethoprim/sulfamethoxazole (TMP/SMX). Methenamine is another agent used for this purpose as in the bladder where the acidity is low it produces formaldehyde to which resistance does not develop. Some recommend again prolonged use due to concerns of antibiotic resistance.

In cases where infections are related to intercourse, taking antibiotics afterwards may be useful. In post-menopausal women, topical vaginal estrogen has been found to reduce recurrence. As opposed to topical creams, the use of vaginal estrogen from pessaries has not been as useful as low dose antibiotics. Antibiotics following short term urinary catheterization decreases the subsequent risk of a bladder infection. A number of vaccines are in development as of 2011.

Children

The evidence that preventative antibiotics decrease urinary tract infections in children is poor. However recurrent UTIs are a rare cause of further kidney problems if there are no underlying abnormalities of the kidneys, resulting in less than a third of a percent (0.33%) of chronic kidney disease in adults. Whether routine circumcisions prevents UTIs has not been well studied as of 2011.

Alternative medicine

Some research suggests that cranberry (juice or capsules) may decrease the number of UTIs in those with frequent infections. A Cochrane review concluded that the benefit, if it exists, is small. Long-term tolerance is also an issue with gastrointestinal upset occurring in more than 30%. Cranberry juice is thus not currently recommended for this indication. As of 2011, intravaginal probiotics require further study to determine if they are beneficial.

Treatment

The mainstay of treatment is antibiotics. Phenazopyridine is occasionally prescribed during the first few days in addition to antibiotics to help with the burning and urgency sometimes felt during a bladder infection. However, it is not routinely recommended due to safety concerns with its use, specifically an elevated risk of methemoglobinemia (higher than normal level of methemoglobin in the blood). Acetaminophen (paracetamol) may be used for fevers. There is no good evidence for the use of cranberry products for treating current infections.

Asymptomatic bacteriuria

Those who have bacteria in the urine but no symptoms should not generally be treated with antibiotics. This includes those who are old, those with spinal cord injuries, and those who have urinary catheters. Pregnancy is an exception and it is recommended that women take 7 days of antibiotics. If not treated it causes up to 30% of mothers to develop pyelonephritis and increases risk of low birth weight and preterm birth. Some also support treatment of those with diabetes mellitus and treatment before urinary tract procedures which will likely cause bleeding.

Uncomplicated

Uncomplicated infections can be diagnosed and treated based on symptoms alone. Oral antibiotics such as trimethoprim/sulfamethoxazole (TMP/SMX), nitrofurantoin, or fosfomycin typically first line. Cephalosporins, amoxicillin/clavulanic acid, or a fluoroquinolone may also be used. These medications substantially shorten the time to recovery with all being equally effective. A three-day treatment with trimethoprim, TMP/SMX, or a fluoroquinolone is usually sufficient, whereas nitrofurantoin requires 5–7 days. Fosfomycin may be used as a single dose.

With treatment, symptoms should improve within 36 hours. About 50% of people will recover without treatment within a few days or weeks. The Infectious Diseases Society of America does not recommend fluoroquinolones as first treatment due to the concern of generating resistance to this class of medication. Amoxicillin-clavulanate appears less effective than other options. Despite this precaution, some resistance has developed to all of these medications related to their widespread use. Trimethoprim alone is deemed to be equivalent to TMP/SMX in some countries. For simple UTIs, children often respond to a three-day course of antibiotics. Women with recurrent simple UTIs may benefit from self-treatment upon occurrence of symptoms with medical follow-up only if the initial treatment fails.

Complicated

Complicated UTIs are more difficult to treat and usually requires more aggressive evaluation, treatment and follow-up. It may require identifying and addressing the underlying complication. Increasing antibiotic resistance is causing concern about the future of treating those with complicated and recurrent UTI.

Pyelonephritis

Pyelonephritis is treated more aggressively than a simple bladder infection using either a longer course of oral antibiotics or intravenous antibiotics. Seven days of the oral fluoroquinolone ciprofloxacin is typically used in areas where the resistance rate is less than 10%. If the local resistance rates are greater than 10%, a dose of intravenous ceftriaxone is often prescribed. Trimethoprim/sulfamethoxazole or amoxicillin/clavulanate orally for 14 days is another reasonable option. In those who exhibit more severe symptoms, admission to a hospital for ongoing antibiotics may be needed. Complications such as urinary obstruction from a kidney stone may be considered if symptoms do not improve following two or three days of treatment.

Epidemiology

Urinary tract infections are the most frequent bacterial infection in women. They occur most frequently between the ages of 16 and 35 years, with 10% of women getting an infection yearly and 60% having an infection at some point in their lives. Recurrences are common, with nearly half of people getting a second infection within a year. Urinary tract infections occur four times more frequently in females than males. Pyelonephritis occurs between 20–30 times less frequently. They are the most common cause of hospital acquired infections accounting for approximately 40%. Rates of asymptomatic bacteria in the urine increase with age from two to seven percent in women of child bearing age to as high as 50% in elderly women in care homes. Rates of asymptomatic bacteria in the urine among men over 75 are between 7-10%. Asymptomatic bacteria in the urine occurs in 2% to 10% of pregnancies.

Urinary tract infections may affect 10% of people during childhood. Among children urinary tract infections are the most common in uncircumcised males less than three months of age, followed by females less than one year. Estimates of frequency among children however vary widely. In a group of children with a fever, ranging in age between birth and two years, two to 20% were diagnosed with a UTI.

Society and culture

In the United States, urinary tract infections account for nearly seven million office visits, a million emergency department visits, and one hundred thousand hospitalizations every year. The cost of these infections is significant both in terms of lost time at work and costs of medical care. In the United States the direct cost of treatment is estimated at 1.6 billion USD yearly.

History

Urinary tract infections have been described since ancient times with the first documented description in the Ebers Papyrus dated to c. 1550 BC. It was described by the Egyptians as "sending forth heat from the bladder". Effective treatment did not occur until the development and availability of antibiotics in the 1930s before which time herbs, bloodletting and rest were recommended.

Pregnancy

Urinary tract infections are more concerning in pregnancy due to the increased risk of kidney infections. During pregnancy, high progesterone levels elevate the risk of decreased muscle tone of the ureters and bladder, which leads to a greater likelihood of reflux, where urine flows back up the ureters and towards the kidneys. While pregnant women do not have an increased risk of asymptomatic bacteriuria, if bacteriuria is present they do have a 25-40% risk of a kidney infection. Thus if urine testing shows signs of an infection—even in the absence of symptoms—treatment is recommended. Cephalexin or nitrofurantoin are typically used because they are generally considered safe in pregnancy. A kidney infection during pregnancy may result in premature birth or pre-eclampsia (a state of high blood pressure and kidney dysfunction during pregnancy that can lead to seizures).

References

External links

• Urinary tract infection at DMOZ

UpToDate Contents

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• 1. 乳児および1ヶ月以上の小児における尿路感染症：急性期マネージメント、画像検査、および予後 urinary tract infections in infants and children older than one month acute management imaging and prognosis
• 2. 女性における急性単純性膀胱炎および腎盂腎炎 acute uncomplicated cystitis and pyelonephritis in women
• 3. 乳児および1ヶ月以上の小児における尿路感染症：臨床的特徴および診断 urinary tract infections in infants and children older than one month clinical features and diagnosis
• 4. 成人における尿道カテーテル関連尿路感染症 catheter associated urinary tract infection in adults
• 5. Urinary tract infections in children: Epidemiology and risk factors

English Journal

• A Murine Model for Escherichia coli Urinary Tract Infection.

• Hannan TJ1, Hunstad DA2,3.
• Methods in molecular biology (Clifton, N.J.).Methods Mol Biol.2016;1333:159-75. doi: 10.1007/978-1-4939-2854-5_14.
• Urinary tract infections (UTI) are among the most common bacterial infections of humans. The mouse provides an excellent and tractable model system for cystitis and pyelonephritis caused by Escherichia coli and other uropathogens. Using a well-established model of experimental cystitis in which the
• PMID 26468108

• Obesity is independently associated with infection in hospitalised patients with end-stage liver disease.

• Sundaram V1,2, Kaung A2, Rajaram A3, Lu SC1,2, Tran TT1,2, Nissen NN4, Klein AS4, Jalan R5, Charlton MR6, Jeon CY7.
• Alimentary pharmacology & therapeutics.Aliment Pharmacol Ther.2015 Dec;42(11-12):1271-80. doi: 10.1111/apt.13426. Epub 2015 Oct 13.
• BACKGROUND: Infection is the most common cause of mortality in end-stage liver disease (ESLD). The impact of obesity on infection risk in ESLD is not established.AIM: To characterise the impact of obesity on infection risk in ESLD.METHODS: We evaluated the association between infection and obesity i
• PMID 26510540

• Antibacterial effect of butyryl alkannin from Arnebia euchroma against vancomycin-resistant pathogens of Enterococcus faecalis causing urinary tract infections.

• Singh LK1, Maheshwari DK1, Shukla S2.
• Natural product research.Nat Prod Res.2015 Dec;29(24):2299-301. doi: 10.1080/14786419.2015.1004676. Epub 2015 Jan 30.
• This study was carried out to investigate the biomedicinal potential of a bioactive marker component, butyryl alkannin, isolated from n-hexane root extract of Arnebia euchroma against various vancomycin-resistant Enterococcus (VRE) isolates of Enterococcus faecalis causing urinary tract infections.
• PMID 25635653

Japanese Journal

• ウレアーゼ産生菌による尿路感染に伴う高アンモニア血症から意識障害を発症した1例

• 泌尿器科紀要 = Acta urologica Japonica 62(8), 421-425, 2016-08
• NAID 120005841432

• A Phase II Clinical Trial Evaluating the Preventive Effectiveness of Lactobacillus Vaginal Suppositories in Patients with Recurrent Cystitis

• Acta Medica Okayama 70(4), 299-302, 2016-08
• NAID 120005828920

• 委員会報告 JAID/JSC感染症治療ガイドライン2015 : 尿路感染症・男性性器感染症

• 感染症学雑誌 = The journal of the Japanese Association for Infectious Diseases 90(1), 1-30, 2016-01
• NAID 40020725340

Related Links

• Urinary Tract Infections (UTIs) - MedicineNet - Health and ...

Read about urinary tract infection (UTI) treatment, symptoms, home remedies, causes, and more. Learn the specific symptoms of urinary tract infections in men, women, and children. Discover when antibiotics are appropriate for a ...

• Urinary Tract Infection In Adults - National Institute of ...

Describes the causes, symptoms, diagnosis, and treatment of urinary tract infections. ... On this page: What is a urinary tract infection (UTI)? What is the urinary tract? What causes UTIs? How common are UTIs in adults? Who is at ...

Related Pictures

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★リンクテーブル★

リンク元	「尿路感染症」「UTI」
関連記事	「infection」「urinary」「tracing」「tract」

「尿路感染症」

　　[★]

英

urinary tract infection, UTI, urinary tract infections, UTIs

関

尿路感染

定義

• 尿路(腎、尿管、膀胱、尿道など)の感染症。尿道炎は別に取り扱われるらしい

疫学

• 尿路感染症は特に女性に多く、30歳になるまでに4人に1人が罹患。
• 入院患者の1/3は尿路感染症であり、さらにその3/4以上は膀胱カテーテルを留置されいる患者で起こる。

分類

背景

• 一般細菌の上行性感染によって起こることがほとんどであり、
• 単純性尿路感染症：尿路に明らかな基礎疾患がない。

• 急性、20-30歳代の女性に多い

• 複雑性尿路感染症：尿路に感染を起こしやすくなる基礎疾患がある。

• 慢性、高齢の男性に多い

部位

• 上部尿路感染症：腎盂腎炎
• 下部尿路感染症：膀胱炎

病因

• 特異性尿路感染症
• 非特異性尿路感染症

• 一般的な尿路感染症

病原体

SMB.607

外来患者

• Escherichia coli(8割)
• Proteus mirabilis
• coagulase negative staphylococci
• Enterococcus faecalis
• Adenovirus 11(出血性膀胱炎)

院内感染患者

• Escherichia coli(4割)
• Klebsiella pneumoniae
• Enterobacter cloacae
• Proteus mirabilis
• Serratia marcescens
• Pseudomonas aeruginosa
• coagulase negative staphylococci
• Staphylococcus aureus
• Enterococcus faecalis
• Candida albicans

first aid p.162

• Ambulatory..E. coli (50-80%), Klebsiella (8-10%).

Staphylococcus saprophyticus (10-30%) is the 2nd most common cause of UTI in young ambulatory women.

• Hospital..E. coli, Proteus, Klebsiella, Serratia,Pseudomonas.

感染経路

• 外尿道口からの上行性感染

病因

• 冷え、過度の排尿自制、尿流の停滞、経尿道的操作など

症状

• 腎盂腎炎：発熱、腰痛など、
• 膀胱炎では頻尿、排尿痛、残尿感、頻尿など

小児科 SPE.615

• 年長児：

• 上部：発熱、腰痛
• 下部：排尿痛、頻尿、尿の混濁

• 乳幼児：発熱、嘔吐、下痢、食欲不振など非特異的な全身症状
• 新生児：乳幼児の症状　＋　脱水、体重減少、黄疸など。

検査

尿検査

• 尿：混濁
• 尿沈渣：1視野(400倍)5個以上の白血球(膿尿)
• 尿培養：1ml中10^5個以上の細菌　←　中間尿の定量培養

• 症状(頻尿、排泄痛、残尿感)ががあれば、これ以下の菌数でも病因的意義がある。

「UTI」

　　[★] 尿路感染症 urinary tract infection UTI urinary tract infections UTIs

「infection」

　　[★]

• n.

• 感染、伝染、感染症

関

contagion、infect、infectious disease、infestation、transmission、transmit

　 　 　 　 　 　 　

「urinary」

　　[★]

• adj.

• 尿の、尿中の、泌尿器の

関

urinary organ、urinary tract、urine、uro

　 　 　

「tracing」

　　[★]

• n.

• 追跡

関

chase、follow up、follow-up、pursue、pursuit、trace

　 　 　 　

「tract」

　　[★]

• n.

• 路

関

tractus