Urinary system infection

　　Urinary system infections mainly refer to pyelonephritis, cystitis, and urethritis. Due to the special physiological environment during pregnancy, it is easy to suffer from urinary system infections, and the reasons include:

　　1. During pregnancy, the kidneys filter more nutrients such as glucose, amino acids, and water-soluble vitamins, so the content of these substances in urine increases, providing material conditions for bacterial growth.

　　2. During pregnancy, the ureters become thicker, longer, and curved, with reduced peristalsis. Some urine still remains in the ureters after urination, providing conditions for bacterial proliferation.

　　3. During urination, due to the contraction of the bladder, the intravesical pressure increases, which can cause part of the urine to reflux into the ureter and is not easy to return to the bladder, leading to ascending infection.

　　4. During labor, due to the compression of the fetal head, the bottom of the bladder becomes congested and edematous, which is prone to local injury and infection.

　　5. If pregnant women do not pay attention to the hygiene of sexual life, there will be an increase in secretions, and not paying attention to cleaning the labia majora and minora and the prepuce of the vagina can easily contaminate the urethral orifice.

　　6. Gender: Women have shorter urethras and are prone to ascending infections during sexual intercourse. Urinary retention during pregnancy is also easy to cause infection.

　　7. Decreased body resistance such as congenital immune deficiency diseases, diabetes, and chemotherapy after tumor.

　　8. Urological instrument examination such as urethral dilation, indwelling catheter, and urethral bladderoscopy.

　　9. Renal parenchymal lesions such as chronic interstitial nephritis, hyperuricemia, and renal trauma.

　　Urinary tract infections in newborns can complicate with jaundice, high fever convulsions, vomiting, abdominal pain, abdominal distension, urethral obstruction can complicate with pyelonephrosis, and can also complicate with renal scarring and reflux nephropathy, renal pyonephrosis, perinephritis, hypertension, etc.

　　Urinary tract infections in the elderly are prone to complications such as bacteremia, sepsis, and septic shock, which are one of the main causes of sepsis in the elderly (accounting for about 1/3), and should be alerted by clinicians.

　　Newborns are mostly blood-borne infections, with more males than females, and symptoms are not typical. Attention should be paid to whether there is fever or hypothermia, crying, vomiting and diarrhea, jaundice, refusal to breastfeed, weight loss, irritability, convulsions, and urinary tract malformations.

　　Infants have a higher incidence, with more girls than boys. They often have high fever, chills, pale complexion, nausea, frequent vomiting, convulsions, frequent urination, dysuria, or abdominal pain, cloudy urine. Pay attention to the hygiene of the external genitalia and the phimosis of male infants.

　　For children before and after school age, attention should be paid to chills, fever, unilateral or bilateral back pain or percussion pain, frequent urination, dysuria, urgency, hematuria, difficulty in urination, and enuresis.

　　For those with chronic or recurrent attacks, attention should be paid to pale complexion, weight loss, lack of vitality, and growth retardation. For those with long-standing diseases, attention should be paid to the manifestations of renal insufficiency.

　　Common symptoms: (1) Abnormal urination: The common abnormal urination in urinary tract infections is frequent urination, urgency, and dysuria, and urinary incontinence and urinary retention can also be seen. Early in the chronic renal failure caused by chronic pyelonephritis, polyuria can occur, and oliguria or anuria can occur in the later stage. (2) Abnormal urine: Urinary tract infections can cause abnormal changes in urine, common ones include bacteriuria, purulent urine, hematuria, and gas urine, etc. (3) Back pain: Back pain is a common clinical symptom, and diseases of the kidneys and renal periphery are one of the common causes of back pain. When the renal capsule, renal pelvis, and ureter are stimulated or the tension increases, pain can be felt in the腰部. Lower urinary tract infections usually do not cause back pain. Inflammation of the kidneys and renal periphery, such as renal abscess, perinephritis, perinephric abscess, and acute pyelonephritis, often cause persistent and severe pain in the腰部. The back pain caused by chronic pyelonephritis is often酸痛.

　　Pay attention to personal hygiene　Pay attention to personal hygiene in everyday life to prevent bacteria from entering and pathogens from infecting. Wear cotton underwear and pants to keep you fresh, avoid tight and breathable pants, and change your underwear frequently. Do not use public bathhouses or bathtubs for bathing, do not sit on an unsterilized toilet, and do not share a towel with others.

　　Drink more water　The longer urine stays in the bladder, the more bacteria there are - the number of Escherichia coli doubles every 20 minutes. The more bacteria, the more uncomfortable it is. Therefore, the best way to relieve urethral pain is to drink more fluid to flush out the bacteria that cause inflammation. If the urine is clear, it means you are drinking enough water. If the urine has a color, it means you are not drinking enough water.

　　忌动作粗暴　夫妻同房前要清洁身体，尤其是丈夫一定要有爱心，切忌动作粗暴伤害到妻子。

　　性交前后上厕所　这能帮助将阴道内的细菌冲掉－－否则，细菌可能藉由性交被送人膀胱。性交后还应再上一趟厕所，男性的阴茎可将女性尿道口的细菌送人膀胱，因此，排尿能有效地＂洗净＂膀胱。

　　向后擦拭身体　排便后，由前向后擦拭可预防感染。擦拭方式错误是最常见的感染原因之一，同时也易引起复发。你当然希望将细菌向外擦掉，而非向内擦到阴道及尿道口。

　　洗热水澡　这能帮助你减轻疼痛，热水浴通常对发炎的部位有益。

　　使用卫生巾　为何女性较易感染，这可能与性交、插避孕器及塞卫生棉条等有关，需接触阴道的操作，似乎增加感染的可能性。建议那些在月经来时有慢性感染的病人，以卫生巾取代卫生棉条。

　　不要过度清洁　太常坐浴也不好。长期冲洗可能将细菌引入阴道，同时将正常的良性菌冲走，使具感染性的大肠杆菌占据。另外也可能发生尿道不舒服，感觉像尿道感染一般。刺激的消毒皂也可能导致相同结果－－改变阴道的菌群，使人更易受感染。

　　眼用阿司匹林　消炎药对某些人有帮助，它能减轻膀胱发炎。发炎少，灼热就少。

　　补充营养素　①服用维生素ｃ　每天服用１０００毫克左右的维生素ｃ（分成数次服用），将足以酸化尿液，以干扰细菌生长，如果你有再感染或复发的情形，而又正好无处求医，这是个好办法。　注意：有时医生给泌尿系统感染患者的抗生素药无法在酸性的尿液里发挥效果，因此，如果你正服用维生素ｃ，应告知医生。也应告知你服用的量。维生素ｃ不具毒性，但一天１０００毫克算是高剂量，应得到医师的许可。

　　危险讯号　出现下列症状的膀胱感染患者，应尽快去看医生。血尿、下半部背及腰窝疼痛、发烧、恶心或呕吐。

　　检验血、尿常规。尿细菌镜检（中段尿一滴，不离心，滴于玻璃片上，烘干，亚甲蓝或革兰染色，油镜下每视野见一个或更多细菌，表示尿内细菌＞１０万／ｍｌ）。清洁中段尿细菌培养（男性尿细菌计数＞１万菌落／ｍｌ；女性尿＞１０万菌落／ｍｌ，８０％为真性细菌尿；女性１万～１０万菌落／ｍｌ为可疑）。尿浓缩功能试验。必要时进行有关的肾功能检查。

　　Renal ultrasound examination, and necessary renal scans, CT, magnetic resonance, renal scanning, intravenous pyelography, and cysto-urethrogram are performed.

　　1. Encourage patients to drink more water, increase urine output to flush the urinary tract, reduce the time bacteria stay in the urinary tract, and promote the excretion of bacteria and bacterial toxins.

　　2. Provide sufficient calories, rich in protein and vitamins, easily digestible food, a variety of food types to promote appetite, enhance the body's resistance, and provide fluid or semi-liquid diets for children with fever.

　　1. Antibiotic Drug Treatment: It should be used early and treated thoroughly. Effective antibiotics should be selected based on bacterial drug sensitivity tests. Combinationsulfamethoxazole or quinolones, ampicillin or amoxicillin, cephalosporins, and other drugs can be used first, and adjustments can be made after the test results are reported. Treatment course: Since most recurrent cases are caused by reinfection, short-term therapy is often used for urinary tract infections in recent years. For patients sensitive to the antibiotic selected for acute infection, a course of 5 days without fever and 10 days with fever can control the vast majority of cases. Regular follow-up for more than one year after recovery. For recurrent cases, it is recommended: ① For those who do not often recur, treat acutely. ② For those who frequently recur, after controlling acute symptoms, one can use SMZco or one type of quinolone, at a dose of 1/3 to 1/4 of the treatment dose, taken once at bedtime, for a course of 3 to 6 months. ③ For those with frequent recurrent infections or renal parenchymal damage, the course can be extended to 1 to 2 years. ④ To prevent the development of drug-resistant strains, combined therapy or alternating therapy can be used, that is, each drug is used for 2 to 3 weeks and then rotated to improve efficacy.

　　2. Patients with chronic infections accompanied by severe vesicoureteral reflux and obvious scars or other anatomical abnormalities should undergo surgical correction. For those with unilateral pyelonephritis and renal atrophy, hypertension, extremely poor renal function, and good contralateral renal function, surgical nephrectomy can be considered. For bilateral cases, renal transplantation can be considered.