Bacterial Infection Of The Genitourinary Tract
This document was uploaded by user and they confirmed that they have the permission to share it. If you are author or own the copyright of this book, please report to us by using this DMCA report form. Report DMCA
Overview
Download & View Bacterial Infection Of The Genitourinary Tract as PDF for free.
More details
- Words: 1,248
- Pages: 49
BACTERIAL INFECTION OF THE GENITOURINARY TRACT Wu Yudong The First Teaching Hospital of Zhengzhou University
General Principle
Susceptibility factors and defense mechanisms in genitourinary tract infection Bacterial virulence factors Attenuate disease resistence of the body Obstruction factors Anatomy factors
Pathogenesis of Urinary Tract Infection
Ascending Infection Hematogenous Spread Lamphatogenous Spread Direct Extension from another Organ
Outline of Diagnosis and Treatment
Identify diagnosis of urinary tract infection WBC in urine Colony count> 105 ／ ml Location of urinary tract infection Upper or lower urinary tract Any primary disease
Treatment strategy
Bacteria sensitive antibiotic
Treatment of the primary disease
Renal Abscess
Etiology & Pathogenesis
Abscess in renal cortex(carbuncles): -Primary lesion: Infected skin -Spread route: Hematogenous -Pathogenic Bacteria: Staphylococci -Predisposing factor: Diabetes Mellitus, Hemodialysis, Intravenous Drug -Less prevalent today
Etiology & Pathogenesis
Corticomedullary Abscess: -Primary lesion: existing UTIs -Spread route: Ascending -Pathogenic Bacteria: Aerobic gram-negative coliform bacteria -Predisposing factor: VUR, stasis,calculi, pregnancy, neurogenic bladder and diabetes -More common today
Clinical Features Symptoms: Fever, chills, and flank pain------Typical Nausea, vomiting, and malaise--Common Cystitislike symptoms---Abscess communicate with collecting system Signs: Costovertebral angle tenderness abdominal tenderness
Clinical Features
Laboratary findings: -Blood RT: Leukocytosis with a shift toward neutrophils and immature forms -Blood culture: Bacteria -Urinalysis: pyuria and bacteriuria or no growth or distinct from the bacteria forming the abscess
Diagnosis
CT Ultrasound
Management --Antibiotic therapy
Staphylococcal abscess: Penicillinaseresistant penicillin or vancomycin or cephalosporin Typical urinary pathogens: Aminoglycosides or third-generation cephalosporin
Management
Percutaneous CT or ultrasound-guided aspiration and drainage
Open surgical drainage
Prostatitis
Anatomy of the Prostate
Anatomy of the Prostate
verumontanum
General Information
More common urologic diagnosis in men under 50 years of age, the third most common in older men From 10% to 30% of men will have a diagnosis of prostatitis by 79 years of age Understanding of the etiology, diagnosis, and treatment of prostatitis has not advanced with that of other prostate disease
Categorization and criteria for the prostatitis syndromes
Diagnostic Techniques EPS RT WBC>10/HP 4-glass test VB1:first voided 10ml of urine(urethra specimen) VB2:midstream sample(bladder sample) EPS(expressed prostatic secretion) VB3: first voided 10ml of urine following massage Bacterial quantification: If VB2 is sterile or has very low colony counts VB1>EPS and VB3 : Urethra infection VB1<10 fold of EPS and VB3: bacterial prostatitis
Acute Bacterial Prostatitis
Etiology & Pathogenesis Aerobic gram-negative organism: E coli: 80% Pseudomonas aeruginosa, Serratia, Klebsiella, and Proteus species: 10~15% Enterococci: 5~10%
Etiology & Pathogenesis
Reflux of infected urine Invasion by rectal bacteria
Occur in the peripheral zone
Clinical Feature
Fever and chill, malaise, arthralgia, and myalgia Rectal, low back, and perineal pain Urinary urgency, frequency, and dysuria
Acute Urinary retention produced by prostatic swelling
Clinical Feature
Digital examination: tender, enlarged gland; irregularly firm and warm
Cloudy and malodorous urine
Gross hematuria occasionally
Diagnosis
On the basis of symptoms and physical examination alone Blood RT: leukocytosis with a shift toward immature forms Urine RT: pyuria,microscopic hematuria, and bacteria Urine Culture: identify the infecting organism 4-glass test, or any prostate massage, and transurethra catheterization should be avoid
Management
Antibiotic therapy 4~6weeks Against gram-negative rods and enterococci, such as TMP-SMX, ampicillin and aminoglycoside Change to the sensitive antibiotics according to the susceptibility test Supportive measures: Antipyretics, analgesics, stool softeners, hydration, and bed rest Acute urinary retention: suprapubic drainage
Chronic Bacterial Prostatitis
Etiology & Pathogenesis
The causative organisms in chronic bacterial prostatitis are the same as those in acute prostatitis: gram-negative enterics and enterococci Intraprostatic reflux and the ductal anatomy Alkaline prostatic secretions Low level of zinic Intraprostatic bacterial sequestration prostatic calculi
Clinical Features
Dysuria, urgency, frequency, and nocturia
Low back and perineal pain or discomfort
No characteristic findings on digital rectal examination
Diagnosis
Recurrent UTIs EPS RT: leukocyte count> 10 per HPF 4-glass Test: the colony counts in EPS and VB3 should exceed those of VB1 and VB2 by at least 10-fold Positive EPS bacteria culture
Management
Chronic bacterial prostatitis is a difficult and frustrating entity to treat. The course of therapy is long, and definitive cure is often not achieved. The greatest therapeutic difficulties stem from the poor penetration of most antibiotic agents into prostatic fluid and the stubborn loci of bacterial growth within the prostate
Management
Antibiotic therapy fluoroquinolones, TMP-SMX, doxycycline, minocycline, amikacin, and carbenecillin At least 3-4 months of treatment is generally recommended
addition of an alpha blocker to antibiotic therapy significantly reduced the number of symptom recurrences over antibiotics alone
Management Relapsing cases Suppressive therapy Aim: limiting bacterial growth in the urine Regimens: nitrofurantoin (100 mg dally), TMP-SMX (1 single-strength tablet dally), and ciprofloxacin (250 mg daily) Surgical therapy Complete prostatectomy TURP
Complicatons
Recurrent UTIs (reinfections) Infertility Negative impact on quality of life
Chronic Pelvic Pain Syndrome (CPPS)
Etiology & Pathogenesis
the most common form of prostatitis and the most poorly understood Divided into inflammatory (category IIIA) and noninflammatory (category IIIB) forms, based on the presence of leukocytes in prostatic fluid Clinical symptoms between the two subgroups are essentially the same
Etiology & Pathogenesis
C trachomatis, ureaplasmas,mycoplasmas, commensal, and anaerobic may be the pathogen, but the role of any infectious organism is still controversial Backflow of urine into prostatic ducts and a subsequent chemically induced inflammatory reaction of the prostate proximal urethra hypertonia--a cause of non inflammatory type Autoimmune process?
Clinical Features
similar to those of chronic bacterial prostatitis Pain symptoms predominate, especially in the perineum, penis, and testicles Voiding dysfunction consisting of dysuria, slow stream, urgency, and frequency also occurs commonly Sexual dysfunction no difference in any symptom parameter between men with inflamed or uninflamed subtypes
Clinical Features
No history of recurrence bladder infection DRE: prostate can be normal or tender
Diagnosis
Inflammatory CPPS EPS RT: elevated leukocytes and lipid-laden macrophages EPS bacteria culture: negative Noninflammatory CPPS Negative laboratory findings Urodynamic evaluation may disclose urethral hypertonia and diminished flow
Management
Definitive treatment for CPPS is not available Antibiotic therapy: fluoroquinolone is useful, If chlamydia is suspected, then tetracycline, minocycline, doxycycline, or erythromycin should be chosen. Antibiotic therapy should probably continue for several weeks Alpha-adrenergic blocking agents: decreasing adrenergic tone in the proximal urethra, alleviating urethral hypertonia and preventing intraprostatic reflux of urine
Management
Xanthine oxidase inhibitor (allopurinol): reduce the concentrations of urate in urine, alleviate chemical irritation in the prostate caused by refluxed urine and reduce the symptoms of CPPS Others: Pelvic floor relaxation techniques, biofeedback, prostate physical therapy (massage), and muscle relaxants may all reduce pelvic floor spasticity Anti-inflammatory agents, sitz baths, transurethral microwave thermotherapy, and normal sexual activity may provide symptomatic relief
Complications
Significant effect on fertility: Lower sperm counts and abnormal morphologic and motility
Quality of life is adversely affected
Prostatic Abscess
Prostatic Abscess
Complications of acute bacterial prostatitis Acute bacterial prostatitis followed by a recrudescence of symptoms suggests abscess formation Clinical picture often mimics that of acute bacterial prostatitis but can be highly variable E coli is the predominant organism
Prostatic Abscess
Transrectal ultrasound or pelvic CT is essential in the diagnosis Treatment Transrectal or percutaneous aspiration and drainage of abscess cavities Transurethral incision and resection Pathogen-specific antibiotics are also required
Prostatic Abscess
Video
General Principle
Susceptibility factors and defense mechanisms in genitourinary tract infection Bacterial virulence factors Attenuate disease resistence of the body Obstruction factors Anatomy factors
Pathogenesis of Urinary Tract Infection
Ascending Infection Hematogenous Spread Lamphatogenous Spread Direct Extension from another Organ
Outline of Diagnosis and Treatment
Identify diagnosis of urinary tract infection WBC in urine Colony count> 105 ／ ml Location of urinary tract infection Upper or lower urinary tract Any primary disease
Treatment strategy
Bacteria sensitive antibiotic
Treatment of the primary disease
Renal Abscess
Etiology & Pathogenesis
Abscess in renal cortex(carbuncles): -Primary lesion: Infected skin -Spread route: Hematogenous -Pathogenic Bacteria: Staphylococci -Predisposing factor: Diabetes Mellitus, Hemodialysis, Intravenous Drug -Less prevalent today
Etiology & Pathogenesis
Corticomedullary Abscess: -Primary lesion: existing UTIs -Spread route: Ascending -Pathogenic Bacteria: Aerobic gram-negative coliform bacteria -Predisposing factor: VUR, stasis,calculi, pregnancy, neurogenic bladder and diabetes -More common today
Clinical Features Symptoms: Fever, chills, and flank pain------Typical Nausea, vomiting, and malaise--Common Cystitislike symptoms---Abscess communicate with collecting system Signs: Costovertebral angle tenderness abdominal tenderness
Clinical Features
Laboratary findings: -Blood RT: Leukocytosis with a shift toward neutrophils and immature forms -Blood culture: Bacteria -Urinalysis: pyuria and bacteriuria or no growth or distinct from the bacteria forming the abscess
Diagnosis
CT Ultrasound
Management --Antibiotic therapy
Staphylococcal abscess: Penicillinaseresistant penicillin or vancomycin or cephalosporin Typical urinary pathogens: Aminoglycosides or third-generation cephalosporin
Management
Percutaneous CT or ultrasound-guided aspiration and drainage
Open surgical drainage
Prostatitis
Anatomy of the Prostate
Anatomy of the Prostate
verumontanum
General Information
More common urologic diagnosis in men under 50 years of age, the third most common in older men From 10% to 30% of men will have a diagnosis of prostatitis by 79 years of age Understanding of the etiology, diagnosis, and treatment of prostatitis has not advanced with that of other prostate disease
Categorization and criteria for the prostatitis syndromes
Diagnostic Techniques EPS RT WBC>10/HP 4-glass test VB1:first voided 10ml of urine(urethra specimen) VB2:midstream sample(bladder sample) EPS(expressed prostatic secretion) VB3: first voided 10ml of urine following massage Bacterial quantification: If VB2 is sterile or has very low colony counts VB1>EPS and VB3 : Urethra infection VB1<10 fold of EPS and VB3: bacterial prostatitis
Acute Bacterial Prostatitis
Etiology & Pathogenesis Aerobic gram-negative organism: E coli: 80% Pseudomonas aeruginosa, Serratia, Klebsiella, and Proteus species: 10~15% Enterococci: 5~10%
Etiology & Pathogenesis
Reflux of infected urine Invasion by rectal bacteria
Occur in the peripheral zone
Clinical Feature
Fever and chill, malaise, arthralgia, and myalgia Rectal, low back, and perineal pain Urinary urgency, frequency, and dysuria
Acute Urinary retention produced by prostatic swelling
Clinical Feature
Digital examination: tender, enlarged gland; irregularly firm and warm
Cloudy and malodorous urine
Gross hematuria occasionally
Diagnosis
On the basis of symptoms and physical examination alone Blood RT: leukocytosis with a shift toward immature forms Urine RT: pyuria,microscopic hematuria, and bacteria Urine Culture: identify the infecting organism 4-glass test, or any prostate massage, and transurethra catheterization should be avoid
Management
Antibiotic therapy 4~6weeks Against gram-negative rods and enterococci, such as TMP-SMX, ampicillin and aminoglycoside Change to the sensitive antibiotics according to the susceptibility test Supportive measures: Antipyretics, analgesics, stool softeners, hydration, and bed rest Acute urinary retention: suprapubic drainage
Chronic Bacterial Prostatitis
Etiology & Pathogenesis
The causative organisms in chronic bacterial prostatitis are the same as those in acute prostatitis: gram-negative enterics and enterococci Intraprostatic reflux and the ductal anatomy Alkaline prostatic secretions Low level of zinic Intraprostatic bacterial sequestration prostatic calculi
Clinical Features
Dysuria, urgency, frequency, and nocturia
Low back and perineal pain or discomfort
No characteristic findings on digital rectal examination
Diagnosis
Recurrent UTIs EPS RT: leukocyte count> 10 per HPF 4-glass Test: the colony counts in EPS and VB3 should exceed those of VB1 and VB2 by at least 10-fold Positive EPS bacteria culture
Management
Chronic bacterial prostatitis is a difficult and frustrating entity to treat. The course of therapy is long, and definitive cure is often not achieved. The greatest therapeutic difficulties stem from the poor penetration of most antibiotic agents into prostatic fluid and the stubborn loci of bacterial growth within the prostate
Management
Antibiotic therapy fluoroquinolones, TMP-SMX, doxycycline, minocycline, amikacin, and carbenecillin At least 3-4 months of treatment is generally recommended
addition of an alpha blocker to antibiotic therapy significantly reduced the number of symptom recurrences over antibiotics alone
Management Relapsing cases Suppressive therapy Aim: limiting bacterial growth in the urine Regimens: nitrofurantoin (100 mg dally), TMP-SMX (1 single-strength tablet dally), and ciprofloxacin (250 mg daily) Surgical therapy Complete prostatectomy TURP
Complicatons
Recurrent UTIs (reinfections) Infertility Negative impact on quality of life
Chronic Pelvic Pain Syndrome (CPPS)
Etiology & Pathogenesis
the most common form of prostatitis and the most poorly understood Divided into inflammatory (category IIIA) and noninflammatory (category IIIB) forms, based on the presence of leukocytes in prostatic fluid Clinical symptoms between the two subgroups are essentially the same
Etiology & Pathogenesis
C trachomatis, ureaplasmas,mycoplasmas, commensal, and anaerobic may be the pathogen, but the role of any infectious organism is still controversial Backflow of urine into prostatic ducts and a subsequent chemically induced inflammatory reaction of the prostate proximal urethra hypertonia--a cause of non inflammatory type Autoimmune process?
Clinical Features
similar to those of chronic bacterial prostatitis Pain symptoms predominate, especially in the perineum, penis, and testicles Voiding dysfunction consisting of dysuria, slow stream, urgency, and frequency also occurs commonly Sexual dysfunction no difference in any symptom parameter between men with inflamed or uninflamed subtypes
Clinical Features
No history of recurrence bladder infection DRE: prostate can be normal or tender
Diagnosis
Inflammatory CPPS EPS RT: elevated leukocytes and lipid-laden macrophages EPS bacteria culture: negative Noninflammatory CPPS Negative laboratory findings Urodynamic evaluation may disclose urethral hypertonia and diminished flow
Management
Definitive treatment for CPPS is not available Antibiotic therapy: fluoroquinolone is useful, If chlamydia is suspected, then tetracycline, minocycline, doxycycline, or erythromycin should be chosen. Antibiotic therapy should probably continue for several weeks Alpha-adrenergic blocking agents: decreasing adrenergic tone in the proximal urethra, alleviating urethral hypertonia and preventing intraprostatic reflux of urine
Management
Xanthine oxidase inhibitor (allopurinol): reduce the concentrations of urate in urine, alleviate chemical irritation in the prostate caused by refluxed urine and reduce the symptoms of CPPS Others: Pelvic floor relaxation techniques, biofeedback, prostate physical therapy (massage), and muscle relaxants may all reduce pelvic floor spasticity Anti-inflammatory agents, sitz baths, transurethral microwave thermotherapy, and normal sexual activity may provide symptomatic relief
Complications
Significant effect on fertility: Lower sperm counts and abnormal morphologic and motility
Quality of life is adversely affected
Prostatic Abscess
Prostatic Abscess
Complications of acute bacterial prostatitis Acute bacterial prostatitis followed by a recrudescence of symptoms suggests abscess formation Clinical picture often mimics that of acute bacterial prostatitis but can be highly variable E coli is the predominant organism
Prostatic Abscess
Transrectal ultrasound or pelvic CT is essential in the diagnosis Treatment Transrectal or percutaneous aspiration and drainage of abscess cavities Transurethral incision and resection Pathogen-specific antibiotics are also required
Prostatic Abscess
Video
Related Documents
Bacterial Infection Of The Genitourinary Tract
July 2020 5
Tuberculosis Of The Genitourinary Tract
July 2020 3
Tumor Of The Genitourinary Tract
July 2020 5
Genitourinary Tract Infections
May 2020 2
Hospital Management: Bacterial Infection
April 2020 18