Urinary tract infection

　　The causes of urinary tract infections include: The most common pathogenic bacteria are Gram-negative bacilli, with Escherichia coli being the most common, followed by Paracolon bacilli, Proteus, Klebsiella, gas-forming bacilli, alkaline bacilli, and Pseudomonas aeruginosa. Pseudomonas aeruginosa often occurs after urinary tract instrument examination; Proteus and Klebsiella are commonly found in patients with urinary tract stones; Coagulase-negative staphylococci (citric and white staphylococci) are more common in women with active sex lives. The pathogenic bacteria are usually one type, and a very few are mixed infections of two or more bacteria. Anaerobic bacterial infections are rare and can occasionally occur in complex urinary tract infections.

　　Complications caused by urinary tract infections are usually severe, so attention should be paid to prevention during treatment.

　　(1) Renal papillary necrosis:It is one of the serious complications of urinary tract infections, often occurring in severe pyelonephritis with diabetes or urinary tract obstruction, and may be complicated by Gram-negative bacillary sepsis or lead to acute renal failure.

　　(2) Perinephric abscess:It often originates directly from severe pyelonephritis (accounting for 90%). The pathogenic bacteria are mostly Gram-negative bacilli, among which Escherichia coli is the most common. Patients often have unfavorable factors such as diabetes and urinary tract stones. In addition to the exacerbation of nephritis symptoms, patients often have obvious unilateral flank pain or tenderness. When the patient bends over to the healthy side, the pain may worsen. X-ray, abdominal flat film, B-ultrasound, pyelography, or renal断层 photography are helpful for diagnosis.

　　(3) Infectious calculi:Pyelonephritis caused by bacteria that decompose urea, such as Proteus and Enterococcus faecalis, can often lead to kidney stones (accounting for 15.4% of the causes of kidney stones), known as infectious calculi. The main component of these stones is ammonium magnesium phosphate, and the small cracks in the stones often harbor pathogenic bacteria. Since antibiotics are difficult to reach these areas, it is easy to lead to treatment failure of urinary tract infections. The combination of infection and urinary tract obstruction can lead to rapid destruction of renal parenchyma, thereby damaging renal function.

　　(4) Gram-negative bacillary sepsis:Urethral infections are one of the main causes of Gram-negative bacillary sepsis, which often occurs in acute symptomatic urinary tract infections, especially after cystoscopy or catheterization. Severe and complicated pyelonephritis, especially those with concurrent acute renal papillary necrosis, are also prone to Gram-negative bacillary sepsis. It may occasionally occur in severe but uncomplicated pyelonephritis. Gram-negative bacillary sepsis is a life-threatening condition, characterized by sudden chills and high fever, often leading to shock with a mortality rate of up to 50%. However, in some elderly patients with benign prostatic hyperplasia or systemic failure, symptoms may not be typical, and there may be no fever or elevated white blood cell count in clinical practice. Attention should be paid to this.

　　Urethral infections are divided into upper urinary tract infections and lower urinary tract infections. Upper urinary tract infections refer to pyelonephritis, while lower urinary tract infections include urethritis and cystitis. Pyelonephritis is further divided into acute pyelonephritis and chronic pyelonephritis.

　　Firstly, acute pyelonephritis:1. Onset is acute; 2. Chills, aversion to cold; 3. Fever; 4. General malaise, headache, and fatigue; 5. Decreased appetite, nausea, and vomiting; 6. Frequent urination, urgency, and dysuria; 7. Back pain, discomfort in the renal area; 8. Pain upon pressing on the upper ureteric point; 9. Pain upon pressing on the costovertebral angle; 10. Pain upon tapping the renal area; 11. Pain upon pressing on the bladder area;

　　Secondly, chronic pyelonephritis:1. The symptoms during an acute attack may be similar to those of acute pyelonephritis, but they are usually much milder, even without systemic symptoms such as fever, malaise, and headache; the symptoms of frequent urination, urgency, and dysuria are also not prominent; 2. Edema; 3. Hypertension;

　　Third, Cystitis and Urethritis:Frequent urination, urgency, dysuria, pain in the bladder area, and urethral discharge.

　　Women should enhance self-protection awareness
　　The special structure of the urinary and reproductive system, with the female urethra being shorter and wider than that of males, makes bacteria more likely to enter. Therefore, women should enhance their awareness of self-protection. Paying attention to the cleanliness and hygiene of the perineum is very important. Menstruation and sexual activity, menstrual blood being the best culture medium for bacteria. Menstrual hygiene, especially the cleanliness and disinfection of menstrual products, is an important link in reducing bacterial invasion.

　　Pay attention to sexual hygiene
　　Sexual intercourse can push bacteria from the anterior urethra to the posterior urethra and bladder through mechanical squeezing actions. There are some cases in clinical practice that occur after sexual intercourse. The purpose of drinking a glass of water before sexual intercourse is to increase urine output; urinating after sexual intercourse can flush and discharge bacteria that have been pushed into the mucous membrane tissue before they invade. If these two methods still cannot prevent urinary tract infections, one dose of antibacterial drugs can be taken after sexual intercourse (the specific drug and dosage should be guided by the doctor), which has an ideal preventive effect and extremely small side effects.

　　Manage the cause
　　Urinary tract infections often have certain triggers, so it is necessary to carefully check whether the patient has urinary tract stones, renal or ureteral malformations, and other conditions. In addition to medication, drinking plenty of water to maintain daily urine output above 2000ml can play a role in urinary tract irrigation and is also very important for the treatment of urinary tract infections.

　　Do not hold urine
　　Holding urine is a common bad habit among women. It can cause two adverse consequences. First, urine stays in the bladder for a long time, and if a small amount of bacteria invades, it has more time to multiply and more time to enter the tissue; second, when the bladder is full, the pressure increases, and urine will reflux upwards to the ureters. If bacteria have already invaded, they will be sent to a higher position, causing pyelonephritis. The solution is of course not to hold urine, and even to develop the good habit of frequent urination.

　　Can supplement Vitamin C
　　Vitamin C can further increase the acidity of urine, making it difficult for various bacteria that cause urethral infections to survive. Active treatment of chronic infectious diseases, such as diabetes, chronic kidney disease, hypertension, and various other chronic diseases, can lead to a decrease in systemic immunity and an increased risk of urinary tract infections. Patients with the aforementioned diseases should be treated promptly and actively, which is an important link in the treatment of urinary tract infections. Drinking plenty of water and urinating frequently, drinking more fluid to flush out the bacteria causing inflammation, has a natural cleansing effect. Pay attention to personal hygiene, wear cotton panties, keep dry and cool, avoid tight and breathable pants, and change your underwear frequently.

　　1. Physical Examination
　　This includes the examination of the urinary and reproductive organs, physical examination of the abdomen and renal area. Pelvic and rectal examinations are significant for differentiating the presence of other diseases.
　　2. Auxiliary Examinations
　　(1) Laboratory tests include routine blood tests, urine tests, urine smear microscopy for bacteria, midstream urine bacterial culture + drug sensitivity, blood bacterial culture + drug sensitivity, and renal function tests, etc.
　　(2) Imaging examinations include ultrasound, abdominal X-ray, intravenous pyelography, and CT or MRI scans can be chosen if necessary.

　　Patients with urinary tract infection should avoid certain foods in their diet, which are commonly as follows.
　　Avoid trigger foods:Trigger foods (such as pork head meat, chicken, mushrooms, hairtail fish, crabs, bamboo shoots, peaches, etc.) can worsen the condition of inflammation and fever, so they should be avoided.
　　Avoid gas-forming foods:Including milk, soy milk, sucrose, etc. Urinary tract infection often causes a feeling of distension and pain in the lower abdomen, and abdominal distension often makes urination more difficult.
　　Avoid products that promote damp-heat:Including alcoholic beverages, desserts, and high-fat foods. This disease is caused by excessive damp-heat, and any product that promotes damp-heat can worsen the condition.
　　Avoid spicy and刺激性 foods:These foods can worsen urinary tract irritation symptoms and make urination difficult. Some can even cause redness and swelling of the urethral opening, and can also cause congestion and pain at the inflamed site.
　　Avoid acidic foods:Acidic foods include pork, eggs, beef, chicken, duck, crucian carp, oysters, shrimp, as well as flour, rice, barley, beer, etc. The acidity and alkalinity of urine are closely related to the growth of bacteria and the antibacterial activity of drugs. The purpose of avoiding acidic foods is to make the urine alkaline environment, enhance the efficacy of antibiotics. Since sugars can also increase acidity in the body, foods with high sugar content also need to be restricted.

　　The main treatment methods for urinary tract infection are as follows:

　　1. Etiological Treatment
　　For chronic cystitis with obvious precipitating factors, it is necessary to eliminate the cause, otherwise, it is difficult to control cystitis. For example, to relieve urinary tract obstruction, remove bladder foreign bodies, stones, etc. For female recurrent cystitis, gynecological examination should be performed to exclude and treat female reproductive tract inflammation; for upper urinary tract infection, male reproductive organ inflammation such as prostatitis, etc., they should be actively treated at the same time.

　　2. General Treatment
　　Patients with urinary system infection should take adequate rest, drink more water to increase urine output, pay attention to nutrition, avoid spicy foods, and hot water sitting bath can alleviate symptoms. Patients with obvious bladder irritation symptoms should be given antispasmodic drugs to relieve symptoms.

　　3. Antimicrobial Drug Treatment
　　Select effective antibacterial drugs according to the results of urine bacterial culture and drug sensitivity test.

　　Expert advice: During the treatment process, it is necessary to perform urine bacterial culture and drug sensitivity test frequently, adjust the antibacterial drugs sensitive to bacteria in time, in order to achieve complete cure as soon as possible and prevent recurrence.