泌尿道感染——病因、诊断与治疗
Urosepsis--Etiology, Diagnosis, and Treatment.
作者信息
Dreger Nici Markus, Degener Stephan, Ahmad-Nejad Parviz, Wöbker Gabriele, Roth Stephan
机构信息
Department of Adult and Pediatric Urology, Witten/Herdecke University, HELIOS, Klinikum Wuppertal, Center for Research in Clinical Medicine (ZFKM), Institute for Microbiology and Laboratory Medicine, Witten/Herdecke University, Center for Research in Clinical Medicine (ZFKM), HELIOS Klinikum, Wuppertal, Department of Intensive Care Medicine, Witten/Herdecke University, HELIOS, Klinikum Wuppertal.
出版信息
Dtsch Arztebl Int. 2015 Dec 4;112(49):837-47; quiz 848. doi: 10.3238/arztebl.2015.0837.
BACKGROUND
Sepsis is among the most common causes of death in Germany. Urosepsis accounts for 9-31% of all cases and has a mortality of 20-40%, which is low compared with that of sepsis in general. As the population ages, the incidence of urosepsis is likely to rise.
METHODS
Review of pertinent articles and guidelines retrieved by a selective search in PubMed.
RESULTS
Enterobacteria and Gram-positive organisms are the pathogens that most commonly cause urosepsis. The diagnosis can and must be made early on the basis of the typical clinical features, altered vital signs, and laboratory abnormalities, so that timely treatment can be initiated. 80% of cases are due to obstructive uropathy. The diagnostic evaluation includes physical examination, blood cultures, urinalysis, procalcitonin measurement, and ultrasonography. In one study, each additional hour of delay in the treatment of urosepsis with antibiotics was found to lower the survival rate by 7.6%. Antibiotics should be chosen in consideration of local resistance patterns and the expected pathogen spectrum.
CONCLUSION
Urologists, intensive care specialists, and microbiologists should all be involved in the interdisciplinary treatment of urosepsis. Patients' outcomes have improved recently, probably because of the frequent use of minimally invasive treatments to neutralize foci of infection. New biomarkers and new treatments still need to be validated in multicenter trials.
背景
脓毒症是德国最常见的死亡原因之一。泌尿系统脓毒症占所有病例的9%-31%，死亡率为20%-40%，与一般脓毒症相比死亡率较低。随着人口老龄化，泌尿系统脓毒症的发病率可能会上升。
方法
回顾通过在PubMed中进行选择性检索获得的相关文章和指南。
结果
肠杆菌科细菌和革兰氏阳性菌是最常引起泌尿系统脓毒症的病原体。基于典型的临床特征、生命体征改变和实验室异常情况能够且必须尽早做出诊断，以便能够及时开始治疗。80%的病例是由梗阻性尿路病引起的。诊断评估包括体格检查、血培养、尿液分析、降钙素原检测和超声检查。在一项研究中，发现泌尿系统脓毒症使用抗生素治疗每延迟一小时，生存率会降低7.6%。应根据当地的耐药模式和预期的病原体谱选择抗生素。
结论
泌尿科医生、重症监护专家和微生物学家都应参与泌尿系统脓毒症的多学科治疗。患者的预后最近有所改善，这可能是因为频繁使用微创治疗来消除感染病灶。新的生物标志物和新的治疗方法仍需在多中心试验中得到验证。
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