泌尿道感染/Urinary tract infection

英文長條目:https://en.wikipedia.org/wiki/Urinary_tract_infection 

目前中文條目:https://zh.wikipedia.org/wiki/%E6%B3%8C%E5%B0%BF%E9%81%93%E6%84%9F%E6%9F%93  

A urinary tract infection (UTI), also known as acute cystitis or bladder infection, is an infection that affects part of the urinary tract.[1]  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.

’’’泌尿道感染’’’({{lang|en|urinary tract infection}},UTI),也稱為急性膀胱炎或膀胱感染,是一種會影響到部分[[泌尿道]]的[[感染]][1]。泌尿道分為上、下泌尿道,感染部位不同對應到不同疾病名稱:當影響到下泌尿道,稱為膀胱炎;當影響到上泌尿道,也就是腎臟的時候,則稱為[[腎盂腎炎]]。不同感染位置,症狀會稍有不同:下泌尿道感染的症狀主要是[[解尿]]時會疼痛,也可能會有頻尿或是一直想要解尿的感覺;上泌尿道感染除了會有跟下泌尿道感染同樣症狀外,還會有[[發燒]]、[[腹痛]]的症狀。有些情況,可能沒有解尿也能感受到尿道灼熱痛感。年長者和很年輕的人若感染,以上症狀可能不會表現得十分明顯。最常見造成泌尿道感染(上下都可能)的病菌是[[大腸桿菌]],而其他細菌、[[病毒]]或[[黴菌]]則鮮少造成感染。

(註解:底線是原文中沒有,潤飾用的,但也不知道好不好,請大家不吝增減~~)

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 women are an exception to this recommendation.

女性其尿道較短,肛門和尿道開口距離也較近,因此較容易有泌尿道感染[中1],約過半數的女性在其一生中有出現過泌尿道感染的情形。泌尿道感染也常會復發。其他的危險因子還包括性交及家族病史。若有出現腎盂腎炎,可能是因為膀胱感染而引起,但也可能是因為{{le|菌血症|blood-borne infection}}而造成。若病患是年輕健康的女性,泌尿道感染可以只以其症狀來診斷。針對一些模糊的症狀,會比較不容易診斷,因為可能有些部位已有細菌存在,只是沒有感染症狀。若是有併發症或是治療不成功的例子,可以進行[[尿液培養]],若頻繁感染,可用低劑量[[抗生素]]進行預防性醫療。

若是沒有併發症的泌尿道感染,可以用短療程抗生素進行治療,不過不少抗生素已用來治療泌尿道感染,細菌[[抗生素抗藥性]]也漸漸提高。若是已有併發症,需要長療程的抗生素或是注射抗生素,若症狀在二至三天還沒有改善,需要進一步的诊断测试。在女性中,泌尿道感染是最常見的細菌感染,每年約會增加10%。若病患在尿液中有病菌或白血球,但沒有症狀,一般不建議使用抗生素,但若病患是已懷孕的婦女,仍需使用抗生素。

Signs and symptoms

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.[3]These symptoms may vary from mild to severe[2] and in healthy women last an average of six days.[4] 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.[2]Rarely the urine may appear bloody[5] or contain visible pus in the urine.[6]

下泌尿道感染也稱為膀胱感染。最常見的症狀是[[排尿時有灼熱感]]與頻尿(或是有排尿的慾望)伴隨著沒有[[陰道分泌物]]與明顯的疼痛[3]。這些症狀可能輕微,也可能嚴重[2],在健康女性身上會持續平均六天[4],[[恥骨]]與[[下背部]]可能會出現些疼痛感。經歷過上泌尿道感染或是[[腎盂腎炎]]的人,可能會有[[側腹痛]],[[發燒]],或是反胃噁心的經驗,以及不同於典型下泌尿道感染的[[不適]]症狀。尿中帶[[血]][5]或尿中出現肉眼可見的[[膿]][6]是非常罕見的。

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.[7]

兒童

對於年幼兒童來說,泌尿道感染的唯一可能症狀是發燒。也因為缺乏明顯的症狀,若兩歲以下女嬰或是未割包皮的一歲以下男嬰有發燒症狀時,醫療機構通常會建議進行尿液培養(culture of urine)。嬰兒泌尿道感染的症狀通常會有食慾降低、嘔吐、嗜睡、或[[黃疸]]等;年紀較大的兒童則會有[[尿失禁]]的現象[7]

Elderly

Urinary tract symptoms are frequently lacking in the elderly.[8] The presentations may be vague with incontinence, a change in mental status, or fatigue as the only symptoms,[3] while some present to a health care provider with sepsis, an infection of the blood, as the first symptoms.[5] Diagnosis can be complicated by the fact that many elderly people have preexisting incontinence or dementia.[8]

It is reasonable to obtain a urine culture in those with signs of  systemic infection that may be unable to report urinary symptoms, such  as when advanced dementia is present.[9] Systemic signs of infection include a fever or increase in temperature of more than 1.1 °C (2.0 °F) from usual, chills, and an increase white blood cell count.[9]

老年人

尿道的症狀在老年人中並不常見[8],它呈現的方式不明顯,但會有尿失禁、 [[心理狀態的改變]]或是疲勞,是其少數可觀察到的症狀[3]。醫護人員可能會在一些患者檢測到[[敗血病]]---血液感染[5]。因為很多老年人可能已有尿失禁或[[失智症]]等問題,因此容易造成診斷上的複雜性[8]

若出現生理系統感染症狀,且無法回報尿道症狀的病患中(例如有進階[[失智症]]的情形),合理的作法是進行[[尿液培養]][9]。生理系統性的感染徵兆包括[[發燒]]、正常體溫上升多於1.1 °C (2.0 °F)、寒顫和[[血液中白血球的增加]] [9]

Cause

E. coli is the cause of 80–85% of community-acquired urinary tract infections, with Staphylococcus saprophyticus being the cause in 5–10%.[2] Rarely they may be due to viral or fungal infections.[10] 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.[5][11][12] Urinary tract infections due to Staphylococcus aureus typically occur secondary to blood-borne infections.[3] Chlamydia trachomatis and Mycoplasma genitalium can infect the urethra but not the bladder.[13] These infections are usually classified as a urethritis rather than urinary tract infection.

病因

[[大腸桿菌]]引起80%~85%的社區性泌尿道感染,而大約5%~10%是由於[[腐生葡萄球菌]]所造成的[2],還有極少數是因病毒或是真菌而感染的[10]。院內的泌尿道感染(大部分和[[導尿管]]有關)包含了非常廣泛的致病原:包括大腸桿菌 (27%)、[[克雷白氏桿菌]] (11%)、[[綠膿桿菌]] (11%)、真菌病原體[[白色念珠菌]] (9%)、腸球菌(7%) [5][11][12]。[[金黃色葡萄球菌]]而造成的泌尿道感染,其比率僅次於由血液傳播而造成的感染[3]。[[披衣菌]]和[[黴漿菌]]會感染尿道,但不會感染膀胱。這些感染通常被分類為[[尿道炎]]而非泌尿道感染。

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.[2] 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.[2] Diaphragm use is also associated.[14] Condom use without spermicide or use of birth control pills does not increase the risk of uncomplicated urinary tract infection.[2][15]

Women are more prone to UTIs than men because, in females, the urethra is much shorter and closer to the anus.[16] As a woman’s estrogen levels decrease with menopause, her risk of urinary tract infections increases due to the loss of protective vaginal flora.[16] Additionally, vaginal atrophy that can sometimes occur after menopause is associated with recurrent urinary tract infections.[17]

Chronic prostatitis may cause recurrent urinary tract infections in males.[18] Risk of infections increases as males age.[18]  While bacteria is commonly present in the urine of older males this  does not appear to affect the risk of urinary tract infections.[18]

在性行為活躍的年輕女性中,75-90%膀胱感染是由性行為引起,且感染的風險與性愛頻率相關[2]   。蜜月膀胱炎(honeymoon cystitis)的術語已經用來描述

在婚姻初期常患有上尿道感染疾病的現象。在[[停經]]後的婦女,性行為不會影響尿道感染的風險。在不考慮性交頻率的情況下,[[殺精劑]](Spermicide)的使用將會增加泌尿道感染的風險 [2] 。而[[隔膜]](Diaphragm)的使用也會有相同的影響 [14]。使用避孕套但不用殺精劑,或服用[[避孕藥]](birth control pills)不會提高無併發症的尿道感染風險 [2] [15]

與男性相較,女性是屬於尿道感染疾病的較高風險群。其原因在於女性的尿道較短,且較接近肛門[16] 。此外,當女性的雌激素(estrogen)隨著[[停經]](menopause)而減少分泌時,尿道感染的機率也會提高,原因是

缺少了[[陰道菌群]](vaginal flora)[17]的保護功能。另外,停經也會導致[[陰道萎縮]](vaginal atrophy),進而造成尿道感染疾病的復發。

[[慢性前列腺炎]](chronic prostitis)也會導致男性尿道感染疾病的復發[18]。其感染風險也會隨著男性的年齡增長提高[18]。而較高齡男性的尿液中普遍上都有細菌的存在,故此點不列入影響尿道感染風險的討論[18]

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.[16] 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.[19][20][21]

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.[22]

[[導尿]]会增加尿道感染的風險。[[菌尿症]](尿裡面有細菌)的風險是每天介乎3-6%, 而預防性的抗生素對正在減少的徵狀性感染是沒有效果的[16]。降低感染風險的方式有:只在有需要的情況下進行導尿、使用[[無菌操作]]插入方式、和保持封閉的、沒有堵塞的導尿管排尿,[19] [20] [21]

男性[[潛水員]]使用[[陰莖套導管]]和女性潛水員在[[乾式潛水衣]]使用外在捕捉器具也比較容易有泌尿道感染的問題[22]

Others

A predisposition for bladder infections may run in families. Other risk factors include diabetes,[2] being uncircumcised, and having a large prostate.[3] Complicating factors are rather vague and include predisposing anatomic, functional, or metabolic abnormalities.[23] In children UTIs are associated with vesicoureteral reflux (an abnormal movement of urine from the bladder into ureters or kidneys) and constipation.[7]

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.[24] It is the most common cause of infection in this population, as well as the most common cause of hospitalization.[24] Additionally, use of cranberry juice or cranberry supplement appears to be ineffective in prevention and treatment in this population.[25]

其他

基因遺傳可能引起泌尿道感染.其他可能造成風險的因素有[[糖尿病]][2],男性未接受[[割禮]],及[[攝護腺肥大]][3].其他複雜的因素相當的模糊,包括誘發結構性,功能性,或是代謝上的異常[23].對於兒童,泌尿道感染與[[膀胱輸尿管返流]]([[尿液]])從膀胱到輸尿管或腎臟的異常流動)及[[便秘]]有關連[7].

患有[[脊椎損傷]]的人因為長期使用導尿管及[[排尿]]的功能異常,有更高泌尿道感染的風險[24].這是此群體受到感染的主要原因之一,也是他們住院的主要緣由[24]而且蔓越莓汁與蔓越莓補給品對這些人群的預防與治療沒有呈現效果[25]。

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.[5]

病理

造成泌尿道感染的[[細菌]]藉由尿道進入膀胱,除此之外亦可能經由血液或[[淋巴]]造成感染症狀。一般科學家認為細菌通常會經由腸道轉移至尿道中,因為性別解剖構造特徵的差異導致女性有更高的尿道感染風險。一旦進入膀胱,E Coli將會黏接在膀胱壁上並且形成[[生物膜]],藉此抵抗人體的免疫反應[5]。

Diagnosis

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.[27] 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.[2] As symptoms can be vague and without reliable tests for urinary tract infections, diagnosis can be difficult in the elderly.[8]

若是一些簡單的泌尿道感染,不須經過實驗檢測確認就可以做出診斷,並依症狀給予治療;在複雜或有疑問的情況,比較有用的是藉[[尿液分析]]來做診斷,檢查其中是否出現[[尿中的亞硝酸鹽]]、[[白血球]]或是[[白血球酯酶]][27]。另外,[[尿液鏡檢]]則可檢查尿中是否出現[[紅血球]]、白血球或細菌。如果每毫升的尿液中細菌菌落數大於等於1000[[菌落形成單位]]時,結果即為陽性。這些培養也能測出對於抗生素的敏感度,有利於抗生素治療的選擇。然而,就算女性經測試後結果為陰性,也可藉由抗生素治療的方式改善[2]。當泌尿道感染的症狀不清楚或是沒有可靠的檢測方式時,對於老年人的診斷較為困難[8]。

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.[3] 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.[4][5] Otherwise if a woman is healthy and premenopausal it is considered uncomplicated.[4] In children when a urinary tract infection is associated with a fever, it is deemed to be an upper urinary tract infection.[7]

泌尿道感染可能只影響了下泌尿道,此情況會稱為膀胱感染。若感染也會包括

上泌尿道,此時便稱為腎盂腎炎。假若尿液當中含有大量的細菌卻沒有症狀時,稱此情況為[[無症狀的菌尿症]][3]。如果上泌尿道遭受感染,並且受感染者為[[糖尿病]]患者、懷孕、男性或是具[[免疫缺陷疾病]]時,此時的泌尿道感染便稱為複雜性的[[4][5]。相反地,如果受感染者是健康且為[[停經前]]的女性,此時的泌尿道便稱為非複雜性的[4]。在兒童的泌尿道感染當中,如果出現了發燒症狀,往往會被認定是上泌尿道感染[7]。

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.[7]

若要確診兒童的泌尿道感染,需要陽性的尿液培養結果。依取樣方法的不同,檢驗可能有檢體污染的情形,是對於檢驗的挑戰。因此,10000個菌落形成單位(CFU/mL)用來作為中段尿檢體的上限,1000個菌落形成單位(CFU/mL)是採用導尿管得到檢體的上限,而100個菌落形成單位(CFU/mL)則是採用[[恥骨上膀胱穿刺吸引術]](直接用注射器從膀胱抽取)得到檢體的上限。[[世界衛生組織|WHO]]並不推薦用「尿袋」來收集檢體,因為極有可能引起檢體污染,而對於不會上廁所的兒童推薦尿道導尿法來收集。像[[美國兒科學會]]等組織對於兩歲以下患有尿路感染的兒童,推薦[[腎超音波檢查]]以及[[解尿中膀胱尿道攝影]](在排尿時使用實時的X射線照射尿道與膀胱)。但是因為尚未發現有效的治療辦法,例如[[英國國家健康與照顧卓越研究院]]等機構,對於小於六個月或者有異常發現的兒童只推薦常規影像檢查[7]。

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.[3][28] These infections are typically classified as a urethritis rather than a urinary tract infection. Vaginitis may also be due to a yeast infection.[29] 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.[30] Prostatitis (inflammation of the prostate) may also be considered in the differential diagnosis.[31]

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.[32] Medications that commonly cause this problem include the chemotherapeutic agent cyclophosphamide with rates of 2 to 40%.[32] Eosinophilic cystitis is a rare condition where eosinophiles are present in the bladder wall.[33] Signs and symptoms are similar to a bladder infection.[33] Its cause is not entirely clear; however, it may be linked to food allergies, infections, and medications among others.[34]

鑑別診斷

[[砂眼披衣菌]]及[[淋病雙球菌]]常常是女性的[[子宮頸炎]]、[[陰道炎]],或是男性的泌尿生殖道感染的常見致病菌種。此類的感染習慣上會被分類為[[尿道感染]]而˙不是泌尿道感染。陰道炎也可能導因於[[酵母菌感染]][29]。若歷經多次泌尿道感染症狀但尿液培養呈現陰性的患者,可能得到的是[[間質性膀胱炎]],且症狀並不會因為抗生素的治療而改善[30]。[[攝護腺炎]]也需要被列入鑑別診斷當中[31]。

[[出血性膀胱炎]]的特色是[[血尿|尿液中會出現血]],而這種疾病的原因包括:感染、[[放射線治療]]、癌症、藥物或是毒素。會造成此症狀的藥物包括[[化療藥物]]癌德星(cyclophosphamide),發生率為2%到40%[32]。[[嗜酸性膀胱炎]]是相對罕見的症狀,此時膀胱壁會出現[[嗜酸性白血球]][33],且病徵和症狀與膀胱感染相當類似。此病確切的病因並不是相當清楚,然而推測可能與[[食物過敏]]、[[感染]]以及其他藥物作用有關[34]。

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.[2] There is similarly a lack of evidence surrounding the effect of holding one’s urine, tampon use, and douching.[16] 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.[5] 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.[35]

Using urinary catheters as little and as short of time as possible  and appropriate care of the catheter when used prevents infections.[19]  They should be inserted using sterile technique in hospital however  non-sterile technique may be appropriate in those who self catheterize.[21] The urinary catheter set up should also be kept sealed.[21] Evidence does not support a significant decrease in risk when silver-alloy catheters are used.[36]

預防

以下這些因素尚未被證實是否影響泌尿道感染頻率:包括性交後立即排尿、使用的內褲種類、在排尿或[[排便]]後的個人衛生習慣,以及習慣泡澡或淋浴等一些因素[2]。憋尿、[[衛生棉條]]的使用和灌流器的使用也同樣缺乏影響泌尿道的證據[16]。對於因為使用[[殺精劑]]或[[陰道隔膜]]等避孕方式,而泌尿道感染頻繁的患者,會建議使用替代療法[5]。對於有[[良性攝護腺增生]]的患者,採取坐姿排尿可以改善膀胱排空狀況,進而降低泌尿道感染頻率。[35]

使用導尿管時,時間上盡可能的縮短與適當的護理方式可以避免感染。[19]在醫院應使用無菌技術置入導尿管,但對於可自行置入導尿管的病患,無菌技術較為適合。[21]導尿管也應在安置時保持密封。[21]而證據顯示使用銀合金導尿管並無法有效降低感染風險。[36]

Medications

For those with taking a short course of  antibiotics when each infection occurs is associated with the lowest  antibiotic use.[37] A prolonged course of daily antibiotics is also effective.[2] Medications frequently used include nitrofurantoin and trimethoprim/sulfamethoxazole (TMP/SMX).[5] 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.[38] Some recommend against prolonged use due to concerns of antibiotic resistance.[37]

In cases where infections are related to intercourse, taking antibiotics afterwards may be useful.[5] 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.[39] Antibiotics following short term urinary catheterization decreases the subsequent risk of a bladder infection.[40] A number of vaccines are in development as of 2011.[5]

藥物治療

若希望使用最低劑量的抗生素,可以當每次感染發生時就使用短療程方式服用抗生素[37]。長療程,每天使用抗生素也是有效的[2]。用藥上經常使用呋喃妥因([[nitrofurantoin]])和聯磺甲氧苄啶(trimethoprim/sulfamethoxazole , TMP/SMX)治療。[5]烏洛托品([[Methenamine]])則是另一種可供治療的藥物,在低酸性的膀胱中可以形成[[甲醛]],病原對此藥物不會有抗藥性。[38]一些資料指出,使用抗生素治療應避免長期使用,以免造成[[抗生素抗藥性]]。[37]

對於因性交造成的感染,在性交後立即服用抗生素可以有效治療。[5]對於停經後的婦女,[[外用]]的陰道[[雌激素]]可以降低反覆感染發生。然而相對於外用藥膏,使用含雌激素的[[陰道塞藥]]並不如低劑量的抗生素有效。[39]在短期放置導尿管後服用抗生素可以降低膀胱因導尿管感染的風險。[40]。2011年也有一些[[疫苗]]正在研究中。[5]

Children

The evidence that preventative antibiotics decrease urinary tract infections in children is poor.[41]  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.[42] Whether routine circumcisions prevents UTIs has not been well studied as of 2011.[43]

孩童

沒有足夠證據支持「使用[[預防醫學|預防性]]抗生素可降低孩童泌尿道感染」[41] 。若腎臟沒有潛在的發育異常,重複性泌尿道感染引發進一步的腎臟疾病並不常見,其中導致成年慢性腎臟病的機率小於0.33%[42]。至2011年為止,有關常規包皮環切(割禮)手術能否預防泌尿道感染,並無足夠研究可以得到結論。

Alternative medicine

Some research suggests that cranberry (juice or capsules) may decrease the number of UTIs in those with frequent infections.[44][45] A Cochrane review concluded that the benefit, if it exists, is small.[46] Long-term tolerance is also an issue[46] with gastrointestinal upset occurring in more than 30%.[47] Cranberry juice is thus not currently recommended for this indication.[46] As of 2011, intravaginal probiotics require further study to determine if they are beneficial.[5]

替代性療法

部分研究顯示經常遭感染的病人服用蔓越莓果汁或膠囊,可能可以降低發生泌尿道感染的機率[44][45]。然而一份[[實證醫學]]的研究認為蔓越莓的效益並不高[46]。另外,30%的使用者有腸胃不適的問題[47] ,因此能否長期使用也是值得關切的問題[46]。至2011年為止,陰道內[[益生菌]]是否對泌尿道感染有幫助仍需進一步研究證明[5]。

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.[48] 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).[49] Acetaminophen (paracetamol) may be used for fevers.[50] There is no good evidence for the use of cranberry products for treating current infections.[51][52]

治療

治療的基礎是[[抗生素]]。非那吡啶(Phenazopyridine)偶爾會和抗生素一起使用,對初期膀胱感染造成的燒灼感或頻尿現象有幫助[48]。然而一般常規並不建議使用此藥,因為它提高了正鐵血紅蛋白血症(methemoglobinemia)的風險[49] 。

乙醯胺酚(Acetaminophen)可用來治療發燒[50]。並無足夠證據證明蔓越梅製品可對抗感染[51][52]。

Asymptomatic bacteriuria

Those who have bacteria in the urine but no symptoms should not generally be treated with antibiotics.[53] This includes those who are old, those with spinal cord injuries, and those who have urinary catheters.[54][55] Pregnancy is an exception and it is recommended that women take 7 days of antibiotics.[56][57] If not treated it causes up to 30% of mothers to develop pyelonephritis and increases risk of low birth weight and preterm birth.[58] Some also support treatment of those with diabetes mellitus[59] and treatment before urinary tract procedures which will likely cause bleeding.[55]

無症狀菌尿症

若病患尿液有細菌但沒有臨床症狀時,不需使用抗生素治療[53](包括老年病患、脊椎損傷病患、裝導尿管的病患[54][55] )。懷孕是例外情況,這些病患建議使用7天抗生素治療[56][57],若未接受治療,約30%的病患會惡化為[[腎盂腎炎]],且增高[[低出生體重]](Low birth weight)和[[早產]]的風險[58] 。一些研究也支持在病患有糖尿病的情況[59],或須進行會造成流血的泌尿道檢查[55]下需使用抗生素[55]。

53. Ariathianto, Y (Oct 2011). "Asymptomatic bacteriuria - prevalence in the elderly population.". Australian family physician 40 (10): 805–9. PMID 22003486.

Uncomplicated

Uncomplicated infections can be diagnosed and treated based on symptoms alone.[2] Oral antibiotics such as trimethoprim/sulfamethoxazole (TMP/SMX), nitrofurantoin, or fosfomycin are typically first line.[60] Cephalosporins, amoxicillin/clavulanic acid, or a fluoroquinolone may also be used.[61] However, resistance to fluoroquinolones among the bacterial that cause urinary infections has been increasing.[27] These medications substantially shorten the time to recovery with all being equally effective.[61][62]  A three-day treatment with trimethoprim, TMP/SMX, or a fluoroquinolone  is usually sufficient, whereas nitrofurantoin requires 5–7 days.[2][63] Fosfomycin may be used as a single dose but has been associated with lower rates of efficacy.[27]

無併發症的感染可單獨依照症狀診斷并治療。[2]口服抗生素,例如[[聯磺甲氧苄啶]](TMP/SMX)、[[呋喃妥因]]或[[磷霉素]]是臨床上的一線藥物。[60]也可使用[[頭孢菌素類]]、[[阿莫西林/克拉維酸]]或者[[氟喹諾酮類]]藥物。但是因對氟喹諾酮類藥物的[[抗藥性]]而導致的泌尿道感染正在增加。[27]這些藥效相近的藥物可以極大地縮短痊癒時間。[61][62]使用甲氧苄啶、聯磺甲氧苄啶(TMP/SMX)或者氟喹諾酮類藥物的三天療程一般來說是有效的,然而使用呋喃妥因則需五到七天的療程。[2][63]磷霉素可以按照單次劑量使用,但已被證實這樣使用藥效不佳。[27]

With treatment, symptoms should improve within 36 hours.[4] About 50% of people will recover without treatment within a few days or weeks.[2] Fluoroquinolones are not recommended as a first treatment.[27][64] The Infectious Diseases Society of America states this due to the concern of generating resistance to this class of medication.[63] Amoxicillin-clavulanate appears less effective than other options.[65] Despite this precaution, some resistance has developed to all of these medications related to their widespread use.[2] Trimethoprim alone is deemed to be equivalent to TMP/SMX in some countries.[63] For simple UTIs, children often respond to a three-day course of antibiotics.[66]  Women with recurrent simple UTIs may benefit from self-treatment upon  occurrence of symptoms with medical follow-up only if the initial  treatment fails.[2]

通過治療,症狀應在36小時內有所緩解。[4]大約百分之五十的人在幾天或幾週內即使沒有治療也會痊癒。[2]美國傳染病協會(IDSA)因擔心對此類藥物[[抗藥性]]的增加而並不推薦[[氟喹諾酮]]類藥物作為治療的首選藥物。[27][64][63][[阿莫西林-克拉維酸]]的治療效果也不如其他的用藥。[65]儘管有如此的預防措施,但因為這些藥物的廣泛使用,人對上述所有藥物的抗藥性還是有所增加。[2]在一些國家,[[甲氧苄啶]]與聯磺甲氧苄啶(TMP/SMX)是相等的藥物。[63]對於病情較輕的泌尿路感染,兒童常常經三天的抗生素治療即有效果。[66]對於泌尿路感染病情較輕但反覆發作的女性,可在當症狀出現時自我治療,或在初始治療無效時尋求專業幫助。[2]

Complicated

Complicated UTIs are more difficult to treat and usually requires more aggressive evaluation, treatment and follow-up.[67] It may require identifying and addressing the underlying complication.[68] Increasing antibiotic resistance is causing concern about the future of treating those with complicated and recurrent UTI.[69][70]

併發性

併發性泌尿道感染比較難以治療,且常常需要更積極的評估、治療和追蹤[67] 。這可能需要確定和解決潛在的併發症[68] 。在治療併發性或復發性的泌尿道感染時,需考慮未來是否會造成[[抗生素抗藥性]]的增加[69][70]。

Pyelonephritis

Pyelonephritis is treated more aggressively than a simple bladder infection using either a longer course of oral antibiotics or intravenous antibiotics.[71] 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.[71] Trimethoprim/sulfamethoxazole or amoxicillin/clavulanate orally for 14 days is another reasonable option.[72] In those who exhibit more severe symptoms, admission to a hospital for ongoing antibiotics may be needed.[71] Complications such as urinary obstruction from a kidney stone may be considered if symptoms do not improve following two or three days of treatment.[3][71]

腎盂腎炎

[[腎盂腎炎]]的治療比簡單的膀胱感染更為積極,使用口服抗生素或靜脈注射抗生素的病程較長[71] 。若抗藥性發生率少於10%的地區,典型的處方是口服fluoroquinolone ciprofloxacin七天。如果局部抗藥性發生率大於10%,醫囑通常會開立靜脈注射一劑ceftriaxone[71] 。Trimethoprim/sulfamethoxazole 或 amoxicillin/clavulanate口服14天是另一個較合理的選項.[72] 。在那些表現出更嚴重的症狀的人,可能需要住院,持續的服用抗生素[71]。如果症狀在治療後的兩到三天沒有改善,可能要考慮像是[[腎結石]]造成[[泌尿道阻塞]]的併發症.[3][71]。

Epidemiology

Urinary tract infections are the most frequent bacterial infection in women.[4]  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.[2][5]  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.[5] Pyelonephritis occurs between 20–30 times less frequently.[2] They are the most common cause of hospital acquired infections accounting for approximately 40%.[73]  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.[16] Rates of asymptomatic bacteria in the urine among men over 75 are between 7-10%.[8] Asymptomatic bacteria in the urine occurs in 2% to 10% of pregnancies.[58]

Urinary tract infections may affect 10% of people during childhood.[5]  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.[7]  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.[7]

流行病學

泌尿道感染是女性最常見的細菌感染[4],其中最常發生於年齡16-35歲, 每年約有10%的女性泌尿道感染,且60%的女性在她們的生命中曾有過也會有過泌尿道感染。[2][5]  復發是很常見的,將近一半的人在一年內受到二次感染。女性泌尿道感染的發生率比男性多四倍[5]。腎盂腎炎發生率只有泌尿道感染的1/20至1/30次[2]。它們是[[院內感染]]最常見原因,約佔40%[73],無症狀菌尿症的發生率會隨著年齡增加,從育齡婦女的2-7%到護理之家的老年女性高達50%[16]。無症狀菌尿症的發生率在超過75歲的男性中介於7-10%之間[8]。無症狀菌尿症在懷孕時的發生率則為 2% 至 10% [58]。

10%的人在兒童時期曾有泌尿道感染 [5]。兒童泌尿道感染中最常見的為未割包皮且年齡小於三個月的男嬰,其次是小於一歲的女嬰[7] 。然而兒童發生率的估計變化很大,一群年齡介於出生至兩歲的發燒小孩當中,被診斷有泌尿道感染的比例可以從2%至20%[7]。

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.[5]  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.[73]

社會和文化

在美國,泌尿道感染每年佔將近七百萬人就診,一百萬人急診,以及十萬人住院.[5]。這些感染造成工作時間損失和醫療照護的花費,影響都很顯著。在美國治療的直接花費估計為每年16億美元[73]。

History

Urinary tract infections have been described since ancient times with the first documented description in the Ebers Papyrus dated to c. 1550 BC.[74] It was described by the Egyptians as "sending forth heat from the bladder".[75] Effective treatment did not occur until the development and availability of antibiotics in the 1930s before which time herbs, bloodletting and rest were recommended.[74]

泌尿道感染最早於西元前1550年被記載在[[埃伯斯紙草文稿]]中[74]。古埃及人將泌尿道感染描述為"從膀胱散發出熱"。[75]在1930年代之前,草藥、[[放血]]和休息是建議的處置,直到1930年代抗生素蓬勃發展後,才出現效果顯著的治療方式[74]。

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.[16] 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.[76] 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).[16]

懷孕期間

在[[懷孕]]時期的泌尿道感染會增加腎臟感染的風險。妊娠期間,高濃度的[[黃體素]]升高了輸尿管和膀胱肌肉張力不足的風險,這也導致尿液逆流向上到輸尿管並朝向腎臟的可能性較大。然而妊娠婦女不會增加無症狀菌尿症的風險,如果菌尿出現,會有25-40%腎臟感染的風險[16] 。因此如果尿液測試顯示出感染的跡象-即使是無症狀的-通常會建議治療。一般認為懷孕時使用[[頭孢氨苄]]及[[呋喃妥因]]是安全的,這也是常在懷孕時使用的抗生素[76]。妊娠期間腎臟感染可能造成[[早產]]或[[子癇前症]](妊娠期間處於[[高血壓]]和腎功能不全狀態,可能造成[[癲癇]])[16]。

<!--目前中文條目的內容-->

’’’泌尿道感染’’’({{lang-en|’’’urinary tract infection’’’}},缩写{{lang|en|’’’UTI’’’}})指[[泌尿道]]任何一部份受[[細菌]][[感染]]。雖然[[尿液]]中含有各種液體、[[鹽]]以及廢物,但在健康的膀胱中,尿液是沒有細菌的。當細菌進入[[膀胱]]或[[腎臟]]並在尿液中繁殖,便引起尿道炎。最常見的泌尿道感染是膀胱感染,這通常也被稱為[[膀胱炎]]。另一種尿道炎是腎臟感染,稱為[[腎盂腎炎]](pyelonephritis),是比較嚴重的感染。雖然會引起不適,只要及時就醫,泌尿道感染通常是迅速而容易治療的。

==症狀==

=== 膀胱感染 ===

*[[尿急]](urinary urgency)

*[[頻尿症|尿頻]](urinary frequency),並且在只有少量尿液時仍覺得需要[[尿|排尿]]

*[[夜尿]](nocturia):需要在夜間排尿。

*[[尿道炎]](urethritis):排尿時尿道口感到不適或疼痛,或是整個尿道有燒灼感

*[[排尿困難]](dysuria)

*[[膀胱炎]]

*[[膿尿]](pyuria):尿液含[[膿]]或尿道排膿

*[[血尿]]:尿中帶血

*[[發燒]]:輕微發燒

*[[尿液]]臭和混濁

*[[小便失禁]](urinary incontinence)

*[[排尿時疼痛或灼熱感]]

=== 腎臟感染 ===

* 上述症狀

* [[噁心]]

* [[嘔吐]]

* [[背痛]]、[[腰痛]]或[[腹股溝疼痛]]

* [[腹痛]]

* 肋脊角不適(Costovertebral angle discomfort)

* 寒戰及高尖峰發燒(Shaking chills and high spiking fever)

* 睡覺時出汗

* 極度疲勞

==流行病學==

泌尿道感染最常見於性生活活躍的女性或生育年齡的女性,懷孕婦女、男士前列腺增大、上廁所的習慣差劣、患有[[糖尿病]]或患有[[鐮刀型紅血球疾病]]的人士罹患泌尿道感染的風險也較高。

嬰兒、小孩(小於六歲,[[包皮過長]][[包莖]])和小於50歲男性極少出現泌尿道感染,如有則通常和泌尿道結構畸型(膀胱逆流、尿路阻塞)有關。

下泌尿道感染(lower urinary tract infections)和膀胱炎的主因通常是細菌通過尿道進入,但上泌尿道感染(upper urinary tract infections)如腎盂腎炎則不然。上泌尿道感染的主因可能是[[血原性]](hematogenous)的。

{{fact|[[過敏]]是泌尿道感染的一個隱性因素。舉例來說,對食物過敏可刺激[[膀胱|膀胱壁]],並增加感染此病的機會。 注意飲食並完成過敏測試,以避免可能導致過敏的食品。性交後患泌尿路感染可能是由於對[[乳膠]][[避孕套]]、[[殺精劑]](spermicide)或口服避孕藥過敏。在這種情況下,可以與醫生檢討控制生育的其他方法。

有時候,平時每天的飲水量不足,也是容易泌尿道感染原因之一。}}

==診斷==

從患有排尿困難和頻尿的病人,在其排尿過程中抽取中間的那一段尿液作樣本送往檢驗,並特別留意[[亞硝酸鹽]]、白細胞或[[白細胞酯酶]]是否出現在樣本中。如果有一個較高的細菌負荷而沒有白細胞,則樣本很有可能已受到污染。診斷尿道炎是經尿液[[細菌培養]]證實的。

如果尿液細菌培養呈陰性反應:

*尿道炎的症狀可能指向[[砂眼披衣菌]]或[[淋球菌]]感染。

*膀胱炎的症狀可能指向[[間質性膀胱炎]]。

*對於男性而言,排尿困難可能是由於[[前列腺炎]]。

在嚴重感染(如出現發燒、[[惡寒]]或腰痛)時,可測量[[尿素]]和[[肌酸酐]]以評估腎功能是否已受到影響。

大多數情況下,女性的下尿路感染是良性的,並不需要詳盡的實驗跟進。不過,出生不久的嬰兒的尿道炎必須接受一些影像學檢查,通常是[[逆行尿道造影]],以確定是否出現先天性泌尿道異常(如膀胱輸尿管逆流、尿道瓣膜或尿路阻塞)。男性也必須作進一步的檢查。具體的檢查方法包括[[X光]]、[[核磁共振成像]]和[[X射線斷層成像]]掃描技術。

==治療==

最簡單的泌尿道感染可以透過服用[[抗生素]]如[[甲氧芐啶]](|Trimethoprim)、[[頭孢菌素]]、[[呋喃妥因]]或[[氟化奎林酮類]](fluoroquinolone,如[[環丙沙星]](Ciprofloxacin)、[[左氧氟沙星]](Levofloxacin))治療。通常年輕的成年人連續服用3天,老人則5天。雖然[[Co-trimoxazole]]以前曾在國際間被使用(在美國則繼續被使用),但相比於成分中的甲氧芐啶,額外的[[磺胺]](sulphonamide)只帶來一丁點額外的好處,卻是導致高發病率的輕度[[過敏]]反應和導致一些罕見但嚴重的[[併發症]]的主要原因。

如果病人的[[症狀]]與腎盂腎炎一致,這可能顯示需要[[靜脈注射]]抗生素治療。療法因人而異,通常是[[氨基糖苷類抗生素|氨基糖苷類]],如[[慶大霉素]](Gentamicin)和[[β內醯胺類抗生素]](Beta-lactam antibiotic)如[[氨芐青黴素]]或[[頭孢曲松]]等結合使用,直至發熱消退後的48小時。其後病人可以出院回家口服抗生素5天。

如果病人對 IV antibiotics 反應冷淡(例如持續高燒,腎功能惡化),那麼表明需要掃描成像,以排除在腎內或周圍形成[[膿瘡]],或是存在著一些堵塞組織(如[[結石]]或[[腫瘤]])的可能性。最好的成像方法是[[X射线断层成像|CT掃描]]。

{{fact|作為[[在家治療]],多喝水、頻繁排尿、避免食[[糖]]和含糖食品、飲用未加糖的[[蔓越莓汁]]、服用[[蔓越莓]]濃縮膠囊,以及在每天最後一餐時服用[[維生素C]],可縮短感染的時間。糖分和酒精可以養活引起感染的細菌,並且惡化疼痛和其他症狀。維生素C在夜間會令尿液變酸,阻止細菌在泌尿道生長。}}

如有以下情況建議諮詢醫生意見:

*疼痛是在背部(back region,這可能是腎臟感染)

*疼痛持續

*發燒

*尿液帶血

2016/1/4 已更新到中文維基 "泌尿道感染 " 中

回到工作頁