Urinary tract infections in older women: a clinical review.
Urinary tract infections in older women: a clinical review.
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DOI：
10.1001/jama.2014.303
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发表时间：
2014-02-26
影响因子：
120.7
通讯作者：
Juthani-Mehta, Manisha
中科院分区：
文献类型：
--
作者：
Mody, Lona;Juthani-Mehta, Manisha
老年妇女的无症状菌尿和有症状的尿路感染(UTIs)在门诊中很常见。回顾无症状性菌尿和症状性尿路感染的治疗，以及社区老年妇女尿路感染复发的预防。在Ovid(Medline，SqucINFO，Embase)上搜索在65岁及以上成年人中进行的英语人类研究，并于1946年至2013年11月20日发表在同行评议期刊上。尿路感染的临床范围从无症状的菌尿，到有症状和复发的尿路感染，再到与尿路感染相关的败血症需要住院。最近的证据有助于区分无症状性菌尿和症状性尿路感染。无症状性菌尿在老年妇女中是短暂的，通常不需要任何治疗就能消失，与发病率或死亡率无关。当患者同时具有尿路感染的临床特征和实验室证据时，诊断为症状性尿路感染。除其他原因外，出现下列任何两种症状的患者均符合临床诊断标准：发热、尿急或尿频加重、急性排尿困难、耻骨上压痛、或肋椎角部疼痛或压痛。尿培养阳性(≥105cfu/m L)，有不超过2种尿路病原体和脓尿，确认尿路感染的诊断。复发症状性尿路感染的危险因素包括糖尿病、功能障碍、最近的性行为、既往的泌尿外科手术史、尿潴留和尿失禁。尿路感染的检测在临床上使用试纸测试很容易进行。当尿路感染的预测概率很低时，白细胞酯酶和亚硝酸盐的检测结果为阴性，则排除感染。抗生素的选择是通过鉴定泌尿系病原体、了解局部耐药率和考虑不良反应情况来进行的。6-12个月的慢性抑制性抗生素和阴道雌激素治疗有效地减少了有症状的尿路感染的发作，应该考虑对复发的尿路感染患者进行治疗。在老年妇女中建立症状性尿路感染的诊断需要仔细的临床评估，并可能使用尿液分析和尿培养进行实验室评估。无症状性菌尿应与症状性尿路感染鉴别。老年妇女的无症状性菌尿不应治疗。
Asymptomatic bacteriuria and symptomatic urinary tract infections (UTIs) in older women are commonly encountered in outpatient practice. To review management of asymptomatic bacteriuria and symptomatic UTI and review prevention of recurrent UTIs in older community-dwelling women. A search of Ovid (Medline, PsycINFO, Embase) for English-language human studies conducted among adults aged 65 years and older and published in peer-reviewed journals from 1946 to November 20, 2013. The clinical spectrum of UTIs ranges from asymptomatic bacteriuria, to symptomatic and recurrent UTIs, to sepsis associated with UTI requiring hospitalization. Recent evidence helps differentiate asymptomatic bacteriuria from symptomatic UTI. Asymptomatic bacteriuria is transient in older women, often resolves without any treatment, and is not associated with morbidity or mortality. The diagnosis of symptomatic UTI is made when a patient has both clinical features and laboratory evidence of a urinary infection. Absent other causes, patients presenting with any 2 of the following meet the clinical diagnostic criteria for symptomatic UTI: fever, worsened urinary urgency or frequency, acute dysuria, suprapubic tenderness, or costovertebral angle pain or tenderness. A positive urine culture (≥105 CFU/mL) with no more than 2 uropathogens and pyuria confirms the diagnosis of UTI. Risk factors for recurrent symptomatic UTI include diabetes, functional disability, recent sexual intercourse, prior history of urogynecologic surgery, urinary retention, and urinary incontinence. Testing for UTI is easily performed in the clinic using dipstick tests. When there is a low pretest probability of UTI, a negative dipstick result for leukocyte esterase and nitrites excludes infection. Antibiotics are selected by identifying the uropathogen, knowing local resistance rates, and considering adverse effect profiles. Chronic suppressive antibiotics for 6 to 12 months and vaginal estrogen therapy effectively reduce symptomatic UTI episodes and should be considered in patients with recurrent UTIs. Establishing a diagnosis of symptomatic UTI in older women requires careful clinical evaluation with possible laboratory assessment using urinalysis and urine culture. Asymptomatic bacteriuria should be differentiated from symptomatic UTI. Asymptomatic bacteriuria in older women should not be treated.
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影响因子：
4
作者：
Foxman, B
通讯作者：
Foxman, B
影响因子：
2.2
作者：
Gorter, Kees J.;Hak, Eelko;Rutten, Guy E. H. M.
通讯作者：
Rutten, Guy E. H. M.
DOI：
10.1002/14651858.cd001209.pub2
发表时间：
2004-01-01
期刊：
The Cochrane database of systematic reviews
影响因子：
--
作者：
Albert, X;Huertas, I;Perrota, C
通讯作者：
Perrota, C
影响因子：
3.6
作者：
Eriksson, Irene;Gustafson, Yngve;Olofsson, Birgitta
通讯作者：
Olofsson, Birgitta
影响因子：
11.8
作者：
Gupta, Kalpana;Hooton, Thomas M.;Soper, David E.
通讯作者：
Soper, David E.