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Urine Infection Road

Significant bacteria, contamination and infection is a term used to distinguish. Employment in the urine in the number of bacteria and microorganisms üretradaki anterior is defined as more kontaminasyondan. Usually> 105 colonies / ml are considered reproductive bakteriüri meaningful. However, especially in female patients and 102 of this issue in the period of initial infection colonies / ml up in is known. 

Bakteriüri asymptomatic; Urinary system infeksiyon (USI) without symptoms who received two consecutive urine cultures bakteriüri is significant. 
Alt üriner system infection; Anatomical limited to the bladder (cystitis), often seen in women, dizüri, frequently go to the urine, and sometimes a sense of emergency urine suprapubik watch with precision, the sense bakteriürinin saptandığı ÜSİ’larıdır. 

Acute piyelonefrit; kidney infection and sub-system parankimi or aggregator findings üriner system infection, fever, side pain, accompanied kostolomber of precision in the shape are observed. 

Üriner system infection is not complicated; neurological and structural as is normally the infeksiyonuna üriner system. 

Infection complicated üriner systems: neurological and structural systems as abnormal in the üriner occurring infections. In general, for men, pregnant women and children is complicated by USI edilir.Yine Kabul of renal cystic diseases, and anatomical anomalies, obstruction, neurogenic bladder foreign bodies, diabetes mellitus, renal transplantation, or rezidüel urine prostatit remain in developing infeksiyonlar complicated infections üriner system is considered to be . 

Relapsing: You have received prior treatment üriner system infection in patients, bakteriürinin treatment is repeated with the pre-spawning microorganisms. 

Reinfeksiyon: I have been receiving treatment before the infection üriner system different from the first patient with a microbial infection is the repeats. 

Sterile piüri: urine culture bacteria produce with Explicit piüri. This term is used in fact wrong, because the majority of patients in this group etyolojik klamidya, the tuberculosis bacillus, such as mikoplasma routine urine culture is sterile urine sorumludur.Yani microorganisms can not produce. 

Acute üretral syndrome: Symptoms despite significant bakteriüri eyes. 

Chronic infection üriner system: in spite of treatment in the same bacterial infection during the months in relapslar not insist. 

Chronic piyelonefrit: rekürren ÜSİ’larına depending on the kidneys; intersitisiyum and tübülilerde 

pathological changes will result. 

İntrarenal abscess: Bakteriyemi results emerged after piyelonefrit or serious kidney complications in the apse is a karekterize with that. 

Perinefritik abscess; Renal blood through parankimdeki or microorganisms from the surrounding soft tissue of the renal abscess caused by rewinding and bring it to infeksiyon.

ETHIOLOGY; 

Urinary system, a single bacterial agent is responsible for 95% infeksiyonlarının. Most of the microorganisms isolated in E.coli, although rekürren USI, and especially in the presence of structural abnormality (obstrüktif üropati, congenital anomalies and neurogenic bladder, etc.). Proteus, Pseudomonas, Klebsiella, enterobakter, staphylococcus enterokoklar and etiology of USI suşları holds an important place. In acute cystitis in women sexually active as S.saprophyticus factors in our çıkar.Yapısal disorder that occurs with multiple mikrooorganizma infeksiyonlar be identified. 

Hospital flora source ÜSİ’nda hospital patients kazanır.Yatan etiological importance proteus, Klebsiella, enterobakter, Pseudomonas, and enterokok occur with staphylococcus suşları feet from infeksiyonlar is seen more often by patients. D group also korinobakterium is nozokomiyal pathogens üriner system. Does not take too much space etyolojik ÜSİ’nda anaerob microorganisms. Fungal USI, especially as catheters and antibiotic treatment is frequently seen in patients. In addition, the spawning wayward (fastidious) mikroaerofil microorganisms and may play a role in women etyolojik Gardnerella vaginalis’in is more frequent in women düşünülmüştür.Erişkinde bakteriüri. % 10-20 in women’s lives have once passed USI. Common sexual relations, diaphragm use, such as the spermisid use increases the risk for women infeksiyon. As the years progress, however, is increasing in men bakteriüri frequency. At least 10% of men over the age of Altmışbeş and 20% of women are determined sinde bakteriüri. 

METHODS OF DIAGNOSIS: 

Microscopic examination of urine; 

2000 rpm.de 5 minutes of the centrifuges have been mid-stream urine examination with the zoom all leukocytes; 5-10/ml corresponds to leukocytes. The number of leukocytes in the urine within normal limits 10-50/ml ‘dir. In light of these criteria, a clean urine sample was prepared from the preparations, the 10×100 zoom, 5-10 in each area indicates the upper limit of normal to see leukocytes. 
Leukocyte count procedure than that leukocytes in the cabin is a specific method. Be detected with this method, leukocytes lökositüri as 10/ml accepted. 
Leukocyte esterase testing in the esterase enzyme saptanması PMNL’lerin in urine is a fast method is valid and is in the description piüri

Urine gram of paint; 
Prepared from mid-stream urine sample is not centrifugal spread of bacteria to see at least one in every area, usually a urine culture, 105 cfu / ml bacteria is parallel to produce. This technique does not specifically recognize the rapid growth and is guiding. 
Urine culture: 
Bacteria in the urethra kolonizedir outside. Therefore, methods of work with the risk of contamination of the urine culture samples are available at certain rate. Meaningful to distinguish between contamination infeksiyondan best known definition is required bakteriüri receiving urine culture methods 

Medium flow of urine samples: the routine is the preferred method. Applying this method to be followed in female patients, there are rules. 

Should wash hands, 
Vulva green soap or a cleaner like substance was wet with four different sterile pad with gas from the front to back with the right order to be deleted, with sterile distilled water is wet, with two separate cotton should be rinsed, leaving Labialar first urine to the toilet should be a medium, the culture of the urine should be taken to the container, Culture two hours should be added. (+4 ° C before October 24 will be waiting for hours.) 

In male patients to clean urine sample to get the culture medium is enough to flow. 

With catheters receiving culture: Cooperation or neurological problems that can not work due to defects or ürolojik inserted catheters from patients with aseptic culture conditions may be taken. 
Suprapubik aspiration: This method, to a large group of pregnant women in premature infantlardan available to be a successful method is used rarely because of difficulties with implementation. Pediatric patients can not leave the cases, such as infection or üretral kontaminasyonla some specific clinical situations endikedir. 

Urine produced in the culture of evaluation: 
Two separate urine samples taken from patients with asymptomatic women in the> 105 cfu / ml producing Enterobacteriaceae group bacteria that makes sense. However, gram positive bacteria, fungi and bacteria to the number of spoiled produce> 104-105 cfu / ml can be specified. 
Male patients> 103 cfu / ml producing Enterobacteriaceae group bacteria that makes sense. 

Once symptomatic patients> 105 cfu / ml producing Enterobacteriaceae is not meaningful. However, in patients with symptomatic women 33% to 102-105cfu/ml in producing Enterobacteriaceae group bacteria increases the risk of bacterial infeksiyon. 

Techniques to determine the localization ÜSİ’nin; 

Especially lökositoz, CRP elevation, is guiding sedimentasyondaki increase ÜSİ’nin lokalizsayonunu discern. These parameters are usually with piyelonefrit table. There is usually hematüri macroscopic with microscopic sedimentinde Urine hematüri hemororajik cystitis lehinedir.Yine proteinüri (<2g / L) but not permanent ÜSİ’larında is finding often encountered. 

Other tests used to reliably distinguish cystitis piyelonefritten of the urinary bladder to make a culture based on the quantitative test and Stamey bladder washing Fairey (washout) is a test. 

With the determination of urinary b2 mikroglobülin breakthrough finding is also in favor of piyelonefrit. 

Radiological methods to determine the localization of infection is used rarely. However, structural anomalies and infeksiyona predispozisyon to create ekarte to complications such as abscess perinefritik intravenous contrast-enhanced helical CT for diagnosis ürografiler uygulanabilir.Yine USI can be used. 

TREATMENT: 

Urinary system many controversial issues in the treatment infeksiyonlarında still not solved. And antimicrobial treatment of asymptomatic Bakteriüri need, such as cystitis treatment with a very different perspective piyelonefrit requires treatment. Therefore is very important that physicians determine the localization of the infection. 

Nonspesifik treatment principles: 

Hydration; is Discussed. 
Urine pH’sı; Urine parallel relationship between pH’sının asidifikasyonu is the antibacterial effect. Therefore, during treatment diet made arrangements asiditesi of urine is available. (Eg milk of the patients, meyvesuyu (wild blackberry excluding water) of sodium bicarbonate consumption engellenebilir.Ancak here to remember also the other point of the urine changes pH’sındaki antibiotics used in the activity changes can cause. 

Antimicrobial treatment principles: 

Antimicrobial treatment is the eradication of bacteria in the system üriner purposes. Therefore, treatment follow-up urine culture results, but results may be assessed. 
Four different response to the treatment of a patient Bakteriürik can; 
Kür: Treatment of the 48th Following the end of the treatment received in 1-2 weeks time and the control of urine is produced in culture 
Persistans: a) treatment of the 48th time to continue meaningful bakteriürinin (treatment failure) b) Treatment of the 48th produced in low numbers of pathogens to the time factor (treatment failure or contamination flora) 
Relapsing: Treatment within 2 weeks after the end of the previous factors of pathogens to produce 
Reenfeksiyon: urine after chemotherapy or during the sterilization of an agent that occurs after the new infeksiyon 

Treatment protocols: 

Piyelonefrit: 
Heavy piyelonefrit: sepsis leading the patient symptoms and findings should be admitted to hospital, and urine culture hemokültür way after intravenous antibiotic treatment should be started. The selection of empirical antibiotics Baþlangıçta paint grams of urine can provide information about treatment choices. IV antibiotic regime in hospital after spending a period of 24-48 hours without a fire to be completed in 2 weeks as oral sustainable.
In patients with treatment options; 
1) Community infeksiyonlarında origin urethra; aminoglikozid, aztreonam, üreidopenisilinler, ampicillin-sulbaktam, tikarsilin-klavulonat, 3 generation is preferred sefalosporinler or florokinolonlar. Between agents in the treatment proposed E.coli also identified because of increased resistance to ampicillin and sulphonamides are 

2) should be wider spectrum antipseudomonal treatment Nosokomiyal infeksiyonlarda should include an antibiotic. Seftazidim, sefepim, tikarsilin-klavulonat, aztreonam, imipenem or meropenem is supplied with a aminoglikozid or kinolonla. Antibiotic sensitivity testing of microorganisms in the treatment of factors resulted in patients with renal failure değiştirilir.Yaşlı and the antibiotic sensitivity test results aminoglikozid started by the other alternatives evaluated immediately to an agent should be more secure. 
If in spite of active treatment, fever, and toxic bakteriyemi findings in patients three days a long time still, or intrarenal abscess perinefritik and / or üriner obstruction should be investigated. 
Light and medium violence in piyelonefrit: The patient is thought to adapt to the treatment of vomiting and no complaints oral treatment with the same agent can be planned. 

Alt üriner system infection: 
In simple cystitis (in women) today accepted the treatment duration is 3 days. The patient is above 65 years of age / diabetes is / are pregnant / symptom duration of 7 days is a long / If you have recently anamnezi urethra infection, treatment duration should be set to 7-10 days. Kotrimoksazol oral treatment, florokinolonlar, may be preferred. For these agents can be used in pregnant women, amoksisilin, sefalosporinler, nitrofrantoin may be preferred. The first time a woman is sexually active symptoms and findings of the sub-üriner system is accompanied piüri without culture treatment with antibiotics can be started. 
3-day treatment for men is not enough data about the approach is not recommended, especially for complications prostatit factors taken into consideration the duration of treatment should be 7-10 days. 

Asymptomatic bakteriüri: 
Approach to the patient’s age and features bakteriüriye asymptomatic depends. In pregnant women, children, obstrüktif üropatisi, chronic renal failure, renal transplantation, diabetes, and should begin treatment nötropenisi ones. Asymptomatic patients bakteriürik usually in old age than women and older men are less in proportion to the people of antimicrobial treatment is usually a sterile urine does not ensure that side effects, cost increase and the development of resistant microorganisms such as the risks are. Therefore the bakteriürisi asymptomatic elderly people önerilmemektedir.Ancak treatment of the overall situation worse, and suddenly the bakteriürisi for patients too old now kullanılamaz.Yaşlı asymptomatic patients bakteriüri definition ürosepsisli person may be without fire and that infeksiyon only in patients with mental status changes can watch. Therefore, such patients should begin treatment. 

Recurring infections üriner system: 
Structural anomalies in a non-patient treatment period of 2 weeks should be the first relapsed. Relapsed after 2 weeks of treatment is determined two weeks of treatment are tested once again. In the case of the repeated treatment of the infection period may be extended to 4-6 weeks. (Men should be observed in the relapslarda chronic prostatit ekarte.) Structural abnormalities to be found so this group gives relapsa predizpozisyon structural abnormalities in patients needs to be corrected. 
Long-term treatment amoksisilin, TMP-SMZ, norfloksasin, ciprofloxacin, nitrofrantoin a full dose every day for a period of weeks later, can be used in half dose. 
Treatment of bacteria in order to ensure continuous printing. If treatment occurs at the end of the treatment of relapsed another medication should be repeated, if the treatment period of 6-12 months relapsın continue to be extended. Control on a monthly basis during the term of this follow-up urine culture should be done. 

Reenfeksiyonu Urinary system; 
Can be divided into two. 
a) Frequently non reenfeksiyon; a year or once in 2-3 years with USI: Each attack should be treated on its own for women 3-day treatment of cystitis should be applied. 
b) Frequently reinfeksiyon; more frequently than described above, the resulting infections. More can be seen in middle-aged women. There is no need to treat asymptomatic reinfeksiyonların, because it will not cause damage in patients with renal infeksiyon and toxic side effects of antimicrobial agents is higher. However, in symptomatic patients or renal damage, the attacks should be treated the question. 
Sexually active women is sexual contact with symptomatic reinfeksiyonlar sexual activity after a single dose of chemotherapy proflaktik (TMP-SMZ 80/400 mg or ciprofloxacin 100 mg) should be applied. Common symptoms in patients with symptomatic infeksiyon others who are serious long-term kemoproflaksi apply. For a successful full-dose antibiotics is not necessary to use proflaksi. 50mg per day nitrofrantoin, 40-200mg TMP-SMZ, or florokinolonlar is sufficient. Treatment is continued until the patient is abakteriürik. Checks are done by monthly follow-up urine culture. Frequently oral or vaginal estrogen in women reenfeksiyon the postmenapozal application has been shown reduce the risk of reinfeksiyon.

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