乙烯雌酚治疗老年女性再发性下尿路感染

作者用乙烯雌酚及抗生素３日疗法治疗１３例老年女性再发生性下尿路感染，治愈８例，治愈率６２％；随访６－１８个月，再发次数较用乙烯雌酚前显著下降。提示乙烯雌酚可作为治疗老年女性再发性下尿路感染的药物之一。     

癃清片治疗老年女性下尿路感染的疗效观察

目的观察癃清片对老年女性尿路感染的疗效。方法将40例尿路感染的老年女性患者随机分为治疗组和对照组各20例。两组均按药敏实验结果运用抗生素治疗,癃清片治疗组,癃清片6片/次,2次/d。比较两组疗效。结果停用药物2、6周复查尿培养,治疗组阴性率与对照组无明显差异。结论癃清片不良反应少、耐药少,可以作为老年女性下尿路感染的临床常用药。     

中西医结合治疗老年女性慢性尿路感染62例

尿路感染为临床泌尿系统常见疾病[1],是由病原体侵犯尿路黏膜及组织引起的尿路炎症,受生理及解剖因素影响多发于育龄期女性及绝经后妇女.以往临床对于尿路感染通常采用敏感抗生素治疗,但随着耐药菌株的不断增加[2,3],常导致疾病反复发作,迁延难愈.本文对收治的患者在西药治疗的基础上再辅助以中药方剂治疗,观察分析临床效果. 1 资料与方法 1.1 一般资料 选择2010年5月至2011年12月本院收治的62例老年女性慢性尿路感染患者,依据1999年WHO制定的诊断标准[4],所选患者均确诊为慢性尿路感染,年龄60～78[平均(67.8±2.4)]岁,病程6个月～13年,平均(5.4±1.5)年.     

尿路感染的治疗

尿路感染 (简称尿感 )的治疗原则是杀灭尿菌 ,预防复发和再次感染 ;去除诱因 ;保护肾功能。1　原则(1)应在治疗开始前作细菌定量培养或尿革兰染色检查以确诊。 (2 )积极去除易感因素 :如解除梗阻、结石 ,积极治疗糖尿病等。 (3)治疗疗程应足 ,做到临床缓解与细菌学转阴。 (4)非复杂性下尿路感染对短程治疗反应良好 ,而上尿路感染需长程治疗。 (5 )社区获得性感染 ,特别是初发的 ,通常是由抗生素敏感的菌株所致。 (6 )再发性尿感 ,有尿路器械检查或近期住院的尿感患者 ,应怀疑为抗生素耐药菌株所致。2　根据尿感的不同类型予以不同的治疗2 1…     

泌淋清胶囊治疗老年女性2型糖尿病合并下尿路感染的临床护理体会

目的分析泌淋清胶囊治疗老年女性2型糖尿病合并下尿路感染的临床护理效果。方法选择2018年6月—2019年6月来该院接受疾病治疗的140例老年女性2型糖尿病合并下尿路感染患者为研究对象,将其分为两组,每组70例。患者均使用泌淋清胶囊治疗疾病,同时控制血糖。对照组应用常规护理,观察组应用针对性护理,分析结果。结果对照组受试者治疗有效率为74.3%,观察组为94.3%,差异有统计学意义(P0.05)。结论针对于女性2型糖尿病合并下尿路感染的患者来讲,在使用泌淋清胶囊治疗疾病基础之上,应用针对性护理能够取得满意成效。此法有助于控制细菌感染,因此值得进一步推广。     

老年女性糖尿病尿路感染中医内调外治法症状评分观察

目的探讨观察老年女性糖尿病尿路感染运用中医内调外治症状评分情况。方法选取该院2012年6月—2014年6月80例老年女性2型糖尿病并尿路感染患者,随机分为观察组予自拟内服方200 m L,3次/d;坐浴1000 m L,1次/d。对照组据药敏选用抗生素。疗程4周。治疗前后记录症状积分。结果两组治疗前症状积分P0.05,有可比性。两组治疗后组内症状积分P0.01,均有效;其中排尿不尽、腹胀、腰酸P0.01,观察组优于对照组;半年复发率低于对照组。结论老年女性糖尿病尿路感染运用中医内调外治可减轻症状,特别对排尿不尽、腹胀、腰酸疗效肯定;复发少;无耐药。     

中西医结合治疗老年女性下尿路感染疗效观察

下尿路感染是老年女性常见病、多发病，患者多起病急，病程长，反复发作，很多病人不正规的长期、间歇滥用抗生素，极易造成肝肾蓄积中毒。笔者运用清热解毒中成药配合西药左氧氟沙星治疗老年女性下尿路感染54例，疗效满意。     

三金片治疗再发性尿路感染50例

目的观察三金片治疗再发性尿路感染的临床疗效。方法再发性尿路感染常规治疗后口服三金片,疗程半年。结果经治疗,半年复发率仅为4%。结论三金片治疗再发性尿路感染具有良好的功效。     

五水头孢唑林钠治疗老年糖尿病合并尿路感染的疗效与安全性

目的评价五水头孢唑林钠治疗老年女性糖尿病合并尿路感染患者的疗效与安全性。方法采用随机对照试验设计,将82例老年女性糖尿病合并尿路感染患者随机分为观察组和对照组。观察组42例,静脉滴注五水头孢唑林钠2.0g,2次/d,疗程5～10d;对照组40例,静脉滴注左氧氟沙星0.2g,2次/d,疗程为7～14d。结果观察组和对照组有效率分别为95.24%和87.50%,细菌清除率分别为97.44%和77.14%,两组比较差异均有统计学意义(P0.05)。不良反应发生率分别为2.38%和2.50%,差异无统计学意义(P0.05)。结论五水头孢唑林钠用于治疗老年女性糖尿病患者尿路感染疗效高、安全性好。     

老年女性糖尿病雌激素受体变化及雌激素作用的研究

本文主要初步探讨雌激素及雌激素受体的变化在绝经后老年女性糖尿病患者中的作用及雌激素对糖尿病的辅助治疗机制.     

Predictors of urinary tract infection after menopause: a prospective study

PURPOSE: To describe the incidence of and risk factors for acute cystitis among nondiabetic and diabetic postmenopausal women. METHODS: We conducted a population-based, prospective cohort study of 1017 postmenopausal women, aged 55 to 75 years, who were enrolled in a health maintenance organization and followed for 2 years. A wide range of behavioral and physiologic exposures were assessed at baseline interview and follow-up clinic visits; the main outcome measure was microbiologically confirmed acute symptomatic cystitis. Follow-up was 87% at 12 months and 81% at 24 months. RESULTS: During 1773 person-years of follow-up, 138 symptomatic urinary tract infections occurred (incidence, 0.07 per person-year). Independent predictors of infection included insulin-treated diabetes (hazard ratio [HR] = 3.4; 95% confidence interval [CI]: 1.7 to 7.0) and a lifetime history of urinary tract infection (HR for six or more infections = 6.9; 95% CI: 3.5 to 13.6). Borderline associations included a history of vaginal estrogen cream use in the last month (HR = 1.8; 95% CI: 1.0 to 3.4), a history of kidney stones (HR = 1.9; 95% CI: 1.0 to 3.7), and asymptomatic bacteriuria at baseline (HR = 1.8; 95% CI: 0.9 to 3.5). Sexual activity, urinary incontinence, parity, postcoital urination, vaginal dryness, use of cranberry juice, vaginal bacterial flora, and postvoid residual bladder volume were not associated with incident acute cystitis after multivariable adjustment. CONCLUSION: Insulin-treated diabetes is a potentially modifiable risk factor for incident acute cystitis among postmenopausal women, whereas a lifetime history of urinary tract infection was the strongest predictor. Use of oral or vaginal estrogen was not protective, and a wide range of behavioral and physiologic factors was not associated with acute cystitis episodes in this generally healthy sample.     

Estrogen Replacement Reverses Endothelial Dysfunction in Postmenopausal Women

Purpose: To measure the effect of long-term clinical hormone replacement therapy on brachial artery vasomotor responses, and to compare these responses in premenopausal and postmenopausal women.Patients and Methods: We studied 23 postmenopausal women, including 18 who were evaluated prior to starting clinically indicated oral hormone replacement therapy. Twelve postmenopausal women received estrogen alone, the other 6 were treated with estrogen/medroxyprogesterone combinations. Eleven premenopausal volunteers served as a comparison group. Change in brachial artery diameter in response to postischemic hyperemic flow and sublingual nitroglycerin was measured by ultrasound.Results: The 18 postmenopausal subjects receiving hormone replacement showed a progressive improvement in their postischemic vasodilation. Mean (±SD) postischemic vasodilation was 0.4% ± 7.1% prior to estrogen replacement. There were significant increases in postischemic vasodilation of 4.8% ± 6.6% after 1 month and 8.3% ± 3.4% after 6 months of estrogen replacement. The response to nitroglycerin was similar at all time points studied. Women with the most abnormal responses to hyperemic flow at baseline demonstrated the greatest improvement after 6 months of hormone replacement therapy. Premenopausal and postmenopausal subjects differed in their response to hyperemic flow, with premenopausal women showing 5.8% vasodilatation compared with a 0.6% vasodilation in postmenopausal women (P = 0.046).Conclusions: Endothelial function is abnormal in many postmenopausal women compared with premenopausal women, and in some postmenopausal women it can be enhanced by estrogen replacement therapy. This effect may increase with prolonged use.     

Overactive bladder in the female patient: The role of estrogens

The prevalence of urinary incontinence is known to increase with age, affecting 15% to 35% of community-dwelling women older than 60 years of age, and other studies report a prevalence of 49% in women older than 65 years. Epidemiologic studies have implicated estrogen deficiency in the etiology of lower urinary tract symptoms, although to date the role of estrogen replacement therapy is controversial. The aim of this paper is to review the recent evidence regarding the effect of estrogen in lower urinary tract dysfunction, with a particular emphasis on the management of symptoms suggestive of overactive bladder in postmenopausal women.     

Harnwegsinfektionen

Urinary tract infections occur very frequently in the community and in hospitalized patients and are mainly caused by Escherichia (E.) coli. Depending on virulence determinants of uropathogenic microorganisms and host-specific defense mechanisms, urinary tract infections can manifest as cystitis, pyelonephritis (bacterial interstitial nephritis), bacteremia or urosepsis. Uncomplicated urinary tract infections in otherwise healthy women should be treated for 3?C7 days depending on the antibiotic therapy chosen, even if spontaneous remission rates of up to 40% have been reported. Antibiotics of the first choice for empirical treatment of uncomplicated urinary tract infection are fluoroquinolones, pivmecillinam and fosfomycin. A huge problem is the increasing antimicrobial resistance of uropathogenic microorganisms. Complicated urinary tract infections associated with anatomical and/or functional abnormalities of the urinary tract and/or comorbidities such as diabetes or immunosuppressive therapy, need longer antibiotic treatment (e.g. 10?C14 days) as well as interdisciplinary diagnostic procedures. Treatment of community acquired urosepsis includes cephalosporins of the third generation, piperacillin/tazobactam or ciprofloxacin. For nosocomial urosepsis the combination with an aminoglycoside or a carbapenem is recommended.     

三金片联合抗生素治疗尿路感染在巩固疗效和减少复发率方面的作用

目的观察三金片治疗尿路感染在巩固疗效、减少复发方面的作用。方法将73例确诊尿路感染的患者随机分为2组,分别予以三金片加左氧氟沙星(联合用药组)、左氧氟沙星(单用抗生素组)口服治疗。结果联合用药组的复发率低于单用抗生素组。结论三金片和敏感抗生素联合应用是治疗尿路感染,减少复发率的理想方法。     

Antimicrobial resistance patterns of uropathogens among children in Istanbul, Turkey

Urinary tract infections are a common cause of end-stage renal disease in Turkey. This prospective study investigated the antibiotic resistance patterns of uropathogens in order to recommend appropriate therapeutic protocols for children with urinary tract infections in Istanbul, Turkey. Between October 2007 and October 2008, children presenting with a first episode of urinary tract infection to a pediatric outpatient clinic were enrolled in the study. Urine samples were cultured, and antimicrobial susceptibility testing was performed. Children with proven urinary tract infections underwent imaging studies where available. A total of 126 children with a first episode of community-acquired urinary tract infection were enrolled in the study. The median age was 60.6 months; 84.1% of the children were female. Of the 126 urine samples, Escherichia coli was the leading uropathogen (81.7%), followed by Proteus spp (7.1%), Klebsiella spp (4.0%), Enterococcus spp (3.2%), Enterobacter spp (2.4%), and Pseudomonas spp (1.6%). Among the isolated uropathogens, resistance to ampicillin (85.0%), amoxicillin-clavulanate (73.8%), cefazolin (37.3%) and trimethoprim-sulfamethoxazole (42.9%) was remarkable. A large number of Enterococcus species were resistant to all antimicrobial agents except vancomycin. A country-based evaluation of antibiotic susceptibility is needed to modify antibiotic treatment. Resistance to antimicrobial agents commonly used to treat urinary tract infections (nitrofurantoin, cefixime) is less a problem than resistance to other antimicrobials (aminopenicillins, cephalosporins, trimethoprim-sulfamethoxazole) frequently prescribed for other indications.     

甲磺酸帕珠沙星注射液治疗急性细菌感染的疗效研究

目的评价帕珠沙星治疗急性细菌感染的临床疗效和安全性。方法采用随机、双盲、对照试验的方法,治疗组为甲磺酸帕珠沙星注射液,对照组为左氧氟沙星,每组各20例,纳入对象为呼吸道、泌尿道感染,甲磺酸帕珠沙星用量:轻度感染500 mg Qd静滴;中度感染500 mg B id静滴。左氧氟沙星用量:轻度感染200 mg Qd静滴;中度感染200 mg B id静滴。疗程均为7~14 d。结果甲磺酸帕珠沙星的临床治愈率70.0%(14/20),有效率90.0%(18/20),细菌清除率87.5%(14/16);对照组左氧氟沙星分别为65.0%(13/20),90.0%(18/20),86.7%(13/15)。帕珠沙星和左氧氟沙星不良反应发生率均为8.7%。以上结果经统计学处理,差异均无统计学意义(P均>0.05)。结论甲磺酸帕珠沙星是治疗轻中度呼吸道、泌尿道感染有效、安全的抗菌药物。     

Initial management of serious urinary tract infection

OBJECTIVE: To obtain information necessary for the development of initial antibiotic treatment guidelines for patients with serious urinary tract infections. DESIGN: Retrospective chart review. SETTING: The medical service of a 533-bed university-affiliated community hospital. PATIENTS: 253 unselected patients hospitalized between January 1985 and December 1987 given principal discharge diagnoses of urinary tract infection, pyelonephritis, or gram-negative rod bacteremia originating in the urinary tract. RESULTS: Three clinically distinct groups were identified: women under 50 years old, older women, and men. Escherichia coli was isolated from 93% of young women, 70% of older women, and 46% of men. Pseudomonas aeruginosa was isolated from 39% of men with one or more urinary tract risk factors, including recent or recurrent urinary tract infections and known genitourinary tract abnormality. The overall prevalence of Group D streptococci was only 1%. More than 20% of the patients in each group were bacteremic. In all groups, resistance to ampicillin and first-generation cephalosporins was common. Trimethoprim-sulfamethoxazole was active in 98% of young women and 85% of older women and men without urinary risk factors. CONCLUSIONS: Age and gender identify clinically important subgroups of patients with serious urinary tract infections. Pending culture results, all patients should be considered bacteremic, ampicillin alone should not be prescribed, and antibiotics effective against P. aeruginosa should be given to men, especially those with risk factors.     

Urinary tract infections

Urinary tract infections occur very frequently in the community and in hospitalized patients and are mainly caused by Escherichia (E.) coli. Depending on virulence determinants of uropathogenic microorganisms and host-specific defense mechanisms, urinary tract infections can manifest as cystitis, pyelonephritis (bacterial interstitial nephritis), bacteremia or urosepsis. Uncomplicated urinary tract infections in otherwise healthy women should be treated for 3-7 days depending on the antibiotic therapy chosen, even if spontaneous remission rates of up to 40% have been reported. Antibiotics of the first choice for empirical treatment of uncomplicated urinary tract infection are fluoroquinolones, pivmecillinam and fosfomycin. A huge problem is the increasing antimicrobial resistance of uropathogenic microorganisms. Complicated urinary tract infections associated with anatomical and/or functional abnormalities of the urinary tract and/or comorbidities such as diabetes or immunosuppressive therapy, need longer antibiotic treatment (e.g. 10-14 days) as well as interdisciplinary diagnostic procedures. Treatment of community acquired urosepsis includes cephalosporins of the third generation, piperacillin/tazobactam or ciprofloxacin. For nosocomial urosepsis the combination with an aminoglycoside or a carbapenem is recommended.     

Trimethoprim-sulphadiazine prophylaxis in children with vesico-ureteric reflux

The efficacy of long-term low-dose prophylaxis with co-trimazine (1-2 mg trimethoprim and 4.5-9 mg sulphadiazine per kg body weight) was studied in 55 children with dilated vesico-ureteric reflux. Of 44 girls, there were 13 with break-through urinary tract infection, all caused by resistant bacteria and in all but one case of pyelonephritic type. The recurrence rate was 1.5/100 treatment months. In 11 boys, there were no break-through infections in 311 treatment months. Co-trimazine was thus an effective drug for prevention of urinary tract infection in this high-risk population.