尿路感染的诊治进展

尿路感染是所有细菌感染中最为常见的,尤其常见于孕龄期妇女。现就尿路感染的诊断及治疗进展作一简述。     

Evidence of Antimicrobial Stewardship in the Treatment of Uncomplicated Urinary Tract Infection

Urinary tract infections (UTIs) are a common and costly cause of morbidity. International research shows practice does not align with Infectious Disease Society Association guidelines, with prescribing concordance rates near 40%. This multidisciplinary quality improvement project evaluated the effectiveness of an evidence-based UTI diagnostic and treatment algorithm and provider education to improve prescribing concordance. After implementation of diagnostic and treatment algorithms and provider education prescribing concordance and antimicrobial stewardship as well as provider confidence was significantly improved.     

复发性尿路感染的分期治疗

目的：设计一种药物分期治疗法,以临床治愈为目标,观察其对复发性尿路感染的疗效。方法：采用的药物分期治疗方法为：①治疗期抗生素按常规剂量治疗,直至尿常规正常。待尿常规正常后,再维持治疗4周;②巩固期抗生素减量应用,维持尿常规正常4周;③维持期抗生素减为每晚1次,维持治疗3个月,如尿常规正常则停药;④观察期停用抗生素观察半年。各期尿检查如有反复,则转为前一期治疗。抗生素应用方法为选择几种有效抗生素,在治疗期和巩固期,每种抗生素治疗1周,轮换应用。维持期每种抗生素应用1～2周。结果：68例尿路感染治愈60例（88.2%）,有效6例（8.8%）,无效2例（2.94%）。治愈的60例患者总疗程22～118周,平均50.1±20.65周。治疗期6～75周,平均30.48±15.23周。巩固期4～13周,平均5.28±2.34周。维持期12～30周,平均14.33±3.70周。有38例符合难治性尿路感染,与30例普通型相比,其治疗期、巩固期和总疗程均延长（P〈0.01）。治疗前后血常规、肝肾功能无明显变化。结论：对于复发性尿路感染,采用治疗期、巩固期和维持期的分期治疗,并轮换应用多种抗生素的方法治愈率高,未见血常规、肝肾功能等不良反应。     

百令胶囊对反复发作性尿路感染的治疗作用

探讨百令胶囊对反复发作性尿路感染的治疗作用。５０例年龄５５￣７２岁的女性患者,均有反复发作的尿路感染史６个月以上,将５０例患者随机分成百令胶囊加阿莫西林组（２６例）及单用阿莫西林组（２４例）,治疗３个月后观察３个月,其间症状、体征、尿化验和细菌学检查均正常为治愈。结果前组１５例治愈,后组仅４例治愈（Ｐ〈０．０５）,前者有效率为９２．３％,后者为７０％。说明百令胶囊对提高反复发作尿路感染治愈率有作用     

Symptomatology Of Urinary Tract Infection

Patients with urinary symptoms are commonly seen in family practice. This study reports the rate of urinary symptoms in three teaching practices over one year. The response of the physician to such patients is described. The predictive value of urinary symptoms in the diagnosis of urinary tract infection is examined.     

不同抗生素治疗下泌尿道感染的成本-效果分析

目的：评价不同抗生素治疗下泌尿道感染的成本和疗效。方法：将98例下泌尿道感染病人随机分成两组。分别接受头孢噻肟和对照药物治疗，并对治疗方案的成本-效果进行分析。结果：头孢噻肟和对照药物治疗下泌尿道感染的效果基本相同，没有显著性差异（p〉0．05），药物治疗成本之间存在显著性差异（p〈0．05）。结论：与头孢噻肟相比，对照药物治疗下泌尿道感染的成本-效果较好。     

氧氟沙星和头孢拉定治疗尿路感染的对比分析

氧氟沙星为氟喙诺酮类药物，具有独特抗菌机制尤其抗菌谱广，耐药性低。体内分布广及组织体液浓度高等特点。广泛用于临床，我院医保科门诊以氧氟沙星治疗尿路感染与头孢拉定作对照观察。     

雌激素在治疗绝经期妇女尿路感染中的应用

目的 观察雌激素在治疗绝经期妇女尿路感染中的作用。方法 将５８例绝经期尿路感染妇女随机分为两组：实验组３２例，采用尼尔雌醇、氟哌酸胶囊、呋喃旦啶治疗；对照组２６例，采用氟哌酸胶囊、呋南旦啶治疗。两组有合并症均同时治疗其合并症。结果 实验组有效率明显高于对照组（分别为９０．７％和６１．５％，Ｐ〈０．０５），复发率显低于对照组（分别为９．４％和３０．８％，Ｐ〈０．０１）。结产合雌激素治疗能明显提高     

Antibiogram,Clinical Practice Guidelines,and Treatment of Urinary Tract Infection

Antibiotic resistance challenges nurse practitioners’ treatment of simple outpatient urinary tract infections in young females who present with genitourinary symptoms. Prescribing antibiotics is complicated by the emergence of resistant gram-negative urinary tract pathogens. An antibiogram aids nurse practitioners in determining prescribing information based on local resistance patterns, and a clinical practice guideline provides evidence-based recommendations for prescribing antibiotics. Prescribing based on resistance patterns improves the chances of the initial antibiotic treatment to cure and mitigates antibiotic resistance.     

Treatment of Community-Acquired Acute Uncomplicated Urinary Tract Infection with Sparfloxacin versus Ofloxacin

The efficacy and safety of a 3-day regimen of sparfloxacin were compared with those of a 3-day regimen of ofloxacin for the treatment of community-acquired acute uncomplicated urinary tract infections. Four hundred nineteen women were enrolled in a randomized, open-label, observer-blinded, multicenter study; 204 received sparfloxacin as a 400-mg loading dose on the first day and 200 mg once daily thereafter, and 215 received ofloxacin as 200 mg twice daily. A total of 383 patients met the criteria for clinical evaluability, and 174 were also bacteriologically evaluable; all treated patients were included in the safety analysis. Escherichia coli (86%) and Staphylococcus saprophyticus (4.6%) were the organisms most commonly isolated. Positive clinical responses were obtained 5 to 9 days after therapy in more than 92% of the patients in each group; sustained clinical cure rates 4 to 6 weeks after therapy were 78.3 and 76.9% in the sparfloxacin and ofloxacin groups, respectively. A positive bacteriologic response was observed in 98% of the bacteriologically evaluable patients in each treatment group at 5 to 9 days posttherapy and in 88.2 and 92.6% of the patients in the sparfloxacin and ofloxacin groups, respectively, 4 to 6 weeks after therapy. Almost 90% of all adverse events were of mild or moderate severity; the most frequent events at least possibly related to drug treatment were those common to the fluoroquinolones, namely, nausea, diarrhea, headache, insomnia, and photosensitivity. Photosensitivity was more frequent in the sparfloxacin group (6.9% versus 0.5% in the ofloxacin group); insomnia was more frequent in the ofloxacin group (3.7% versus 1.0% in the sparfloxacin group). These data suggest that a once-daily, 3-day regimen of sparfloxacin is effective and generally well tolerated in the treatment of acute uncomplicated urinary tract infections.     

Factors Governing the Emergence of Resistance to Nalidixic Acid in Treatment of Urinary Tract Infection

Cultures of Escherichia coli were exposed to nalidixic acid in an in vitro model in which the conditions of drug-organism interaction resembled those of bacterial cystitis treatment. Results obtained in this way suggested that emergence of bacterial resistance should not be a major problem in treatment of uncomplicated urinary infection; such cases might indeed respond to a less intensive course of treatment than is usual. More prolonged, high-dosage therapy with nalidixic acid may be required for patients with more complicated infections if the risk of failure from the emergence of bacterial resistance is to be minimized.     

八正散加减治疗泌尿系统感染50例临床疗效观察

目的观察八正散加减治疗泌尿系统感染50例临床疗效。方法选取2013年11月~2014年11月我院收治的100例泌尿系统感染患者,随机分为观察组和对照组各50例。观察组患者使用左氧氟沙星联合中药八正散加减治疗,而对照组患者只使用左氧氟沙星进行治疗。坚持1个月的治疗后,将两组患者的临床疗效、不良反应发生率、症状改善所需时间进行对比。随访6个月,观察两组患者的疾病复发率。结果治疗结束后,观察组患者的临床疗效、症状改善所需时间均明显好于对照组患者;而两组治疗期间的不良反应发生率均较低,无统计学差异(P0.05)。随访期间,对照组患者的疾病复发率明显高于观察组患者,差异有统计学意义(P0.05)。结论临床治疗泌尿系统感染时,使用头孢地尼联合中药八正散加减治疗,能够显著改善临床症状、缩短症状改善所需时间、降低疾病复发率,且药物副作用较轻,可以在临床上推广使用。     

普卢利沙星治疗急性尿路感染的随机双盲对照试验

目的评价普卢利沙星治疗急性尿路感染的有效性和安全性。方法根据本研究的纳入和排除标准,选取急性尿路感染患者144例,按计算机随机表产生的随机号将患者分为两组,进行随机双盲、双模拟对照试验。试验组服用普卢利沙星200mgbid;对照组服用左氧氟沙星200mgbid。疗程均为5～10天。结果两组各有67和61例可进入全分析集(FAS),各有63和59例可进行符合方案集(PP)分析。FAS分析结果显示,试验组和对照组的临床有效率分别为85.07%和88.52%;细菌阴转率试验组为93.75%,对照组为93.88%。PP分析结果显示,试验组和对照组的有效率分别为90.48%和91.53%;细菌阴转率分别为97.83%和97.87%。两组临床疗效和细菌学疗效阴转率差异均无统计学意义(P>0.05)。普卢利沙星和左氧氟沙星的不良反应发生率分别为2.8%和5.6%。结论普卢利沙星对敏感菌引起的尿路感染疗效确切,安全性好。     

Single-Dose Daily Gentamicin Therapy in Urinary Tract Infection

Patients with urinary tract infection were treated for 8 to 15 days with one daily intramuscular injection of 160 mg of gentamicin or 60 or 80 mg every 8 h. Ten of 11 patients treated with one injection daily were cured as compared with 8 of 10 patients treated with three injections daily. Urinary concentrations of gentamicin were 3.2 to 600 mug/ml in all 8-h collections in patients receiving one injection daily and were 22 to 440 mug/ml in all 8-h collections in patients receiving three injections daily. The group treated once daily demonstrated a significant but reversible increase in mean serum creatinine concentration and decrease in mean creatinine clearance during therapy as compared with no change in the group treated with three injections daily. Decreases in renal function were correlated with higher milligram per kilogram doses and higher 1-h serum concentrations.     

Factors Provoking Lower Urinary Tract Infection in Women

Our aim was to evaluate possible risk factors, other than sexual activity, for urinary tract infection (UTI) in women. A case-control study was designed. 50 cases and 50 controls were included.

A larger fraction of cases than controls reported that episodes of the following preceded the UTI: voluntary deferred voiding (Odds ratio 5.0, 95% confidence interval 1.7; 20.1), cold hands (4.7, 1.3; 25.3), cold feet (5.8, 2.0; 22.8), and cold buttocks (5.5, 1.2; 51.0).

Cold body parts should be further evaluated as a possible risk factor for UTI in UTI-prone women.