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1、InfectionofGUTIntroductionDefinitionPathogenstayandgrowinanypartofGUTcausinginfection.BacteriuriaPyuriaBacteriuriawithoutpyuriaindicatesbacterialcolonizationratherthaninfection.Pyuriawithoutbacteriuriawarrantsevaluationfortuberculosis,stones,orcancer.DefensesysteminGUTNormalflorastay
2、inmeatalskinandmucosaofurethra,secretebacteriocin,metabolicproducts,tosuppressthegrowthofpathogen,competenutrientsUrotheliumsecretemucinpreventingbacteriaadhesionAnti-refluxmechanismPredisposingfactorsObstructive:asstones,tumor,stricture,BPHPredisposingfactorsBodyresistance,hypertens
3、ion,diabetes,pregnancyIatrogenic:catherterization,cystoscopyRenalparenchymadiseases:renalinjury,renalfailure,interstitialnephritisAnatomical:femaleurethraRoutesofinfectionAscendingrouteHematogenousrouteLymphaticrouteDirectextensionPathogenGram-negative:85%EscherichiacoliGram-positive
4、:StaphylococcusaureusChlamydiaMycoplasmaDiagnosisClinicalfeaturesLaboratoryinvestigationurinebacterialcultureandcolonycounting:>105/mlUrinecollectionSuprapubicaspirationUrethralcatheterizationSegmentedvoidedurinespecimensMidstreamvoidedurinespecimensLocalizationUreteralcatheterizatio
5、nFairleybladderwashouttestImmunologyresponsesDirectagglutinationtestsPassiveagglutinationtestsAntibody-coatedbacteriaPyelonephritiswerefluorescentantibody-positivecystitiswerenotantibody-coatedEnzyme-linkedimmunosorbentassaysandradioimmunoassayforimmunoglobulinsImmunoglobulinresponse
6、inpyelonephritisImagingtechniquesPlainfilmoftheabdomenIntravenousurogram(IVU)UltrasonographyComputerTomography(CT)PrinciplesoftreatmentSelectsensitiveantibioticsUseatleasttwokindsofsensitiveantibioticstoavoidproductionofdrugresistantstrainUsefulldoseasearlyaspossibleAdministerlowerne
7、phrotoxinantibioticsDurationoftherapyAcutepyelonephrosisClinicalpresentationchills,fever,flankpain,andunilateralorbilateralcostovertebralangletendernessdysuria,increasedurinaryfrequencyandurgencyphysicalexaminationtendernesstodeeppalpationinthecostovertebralangleabdominalpain,nausea,
8、vomiting,dia
