全科临床诊疗思维系列:发热与尿路感染
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摘要
尿路感染常出现发热症状,伴尿路刺激征。根据全身中毒症状、输尿管/肋脊点压痛、肾区叩痛等可进一步鉴别上下尿路感染。社区卫生服务中心通常不具备进行细菌学检查的条件,在无危险症状、危险体征,并排除复杂性尿路感染的基础上,可根据患者的感染部位、发病情况、发病场所、既往抗菌药物用药史及其治疗反应等推测可能的病原体,并结合当地细菌耐药性监测数据,给予抗菌药物经验性治疗并加强随访。
Urological infections often presents with fever,that accompanied with urinary irritation signs.According to the symptoms of systemic poisoning,tenderness of uretral/costovertebral angle,and percussion pain of kidney area,upper and lower urological infection can be further identified.Community health service centers usually do not have the conditions for bacteriological examination.If the patients do not have the life-threatening symptoms and signs,after excluding complicated urinary tract infections,the general practitioners can choose antimicrobial agents experientially on the basis of the site of infection,the incidence,the place of onset,the past history of antimicrobial drugs and their therapeutic reactions,and the local bacterial resistance monitoring data,to give empirical drug therapy and enhanced follow-up.
Urological infections often presents with fever,that accompanied with urinary irritation signs.According to the symptoms of systemic poisoning,tenderness of uretral/costovertebral angle,and percussion pain of kidney area,upper and lower urological infection can be further identified.Community health service centers usually do not have the conditions for bacteriological examination.If the patients do not have the life-threatening symptoms and signs,after excluding complicated urinary tract infections,the general practitioners can choose antimicrobial agents experientially on the basis of the site of infection,the incidence,the place of onset,the past history of antimicrobial drugs and their therapeutic reactions,and the local bacterial resistance monitoring data,to give empirical drug therapy and enhanced follow-up.
引文
[1]Murtagh J.全科医学[M].梁万年,主译.4版.北京:人民军医出版社,2010.
[2]《中华传染病杂志》编辑委员会.发热待查诊治专家共识[J].中华传染病杂志,2017,35(11):641-655.
[3]万学红,陈红.临床诊断学[M].3版.北京:人民卫生出版社,2015.
[4]尿路感染诊断与治疗中国专家共识编写组.尿路感染诊断与治疗中国专家共识(2015版):复杂性尿路感染[J].中华泌尿外科杂志,2015,36(4):241-244.
[5]Porter R S.默克家庭医学手册[M].胡大一,主译.3版.北京:人民卫生出版社,2014.
[6]尿路感染诊断与治疗中国专家共识编写组.尿路感染诊断与治疗中国专家共识(2015版):尿路感染抗菌药物选择策略及特殊类型尿路感染的治疗建议[J].中华泌尿外科杂志,2015,36(4):245-248.
[7]王吉耀.内科学[M].2版.北京:人民卫生出版社,2010.
[8]郑嘉堂,邵靖岚,费秀文,等.全科门诊男性单纯性尿路感染一例分析[J].中华全科医师杂志,2018,17(8):658-660.
[2]《中华传染病杂志》编辑委员会.发热待查诊治专家共识[J].中华传染病杂志,2017,35(11):641-655.
[3]万学红,陈红.临床诊断学[M].3版.北京:人民卫生出版社,2015.
[4]尿路感染诊断与治疗中国专家共识编写组.尿路感染诊断与治疗中国专家共识(2015版):复杂性尿路感染[J].中华泌尿外科杂志,2015,36(4):241-244.
[5]Porter R S.默克家庭医学手册[M].胡大一,主译.3版.北京:人民卫生出版社,2014.
[6]尿路感染诊断与治疗中国专家共识编写组.尿路感染诊断与治疗中国专家共识(2015版):尿路感染抗菌药物选择策略及特殊类型尿路感染的治疗建议[J].中华泌尿外科杂志,2015,36(4):245-248.
[7]王吉耀.内科学[M].2版.北京:人民卫生出版社,2010.
[8]郑嘉堂,邵靖岚,费秀文,等.全科门诊男性单纯性尿路感染一例分析[J].中华全科医师杂志,2018,17(8):658-660.