Diagnostik af UVI

117 Pages·2012·2.93 MB·English

by  Helle Raith

Urinvejsinfektioner
Niels Frimodt-Møller
Professor, overlæge dr.med.
Klinisk Mikrobiologisk Afdeling,
Hvidovre Hospital
Urinvejsinfektioner
• Ætiologi og patogenese
• Overførsel fra dyr?
• Epidemiologi (børn,voksne,ældre)
• Diagnostik
• Behandling (resistens)
Urinvejsinfektion (UVI)
• Urinvejene sterile indtil meatus urethrae
externa
• Def. Af UVI: Mikroorganismer i urin
Urinvejsinfektion
• En af de hyppigste infektioner i almen
praksis (3-400.000/år i DK)
• Forekommer 6 x hyppigere hos kvinder
• 20% af kvinder med UVI recidiverer
• Årsag til stor del af antibiotikaforbruget
• UVI årsag til ½ af E.coli bakteriæmier
• E.coli udgør 80%; kommer fra pts egen
tarmflora
Urinvejsinfektion: Smitteveje
• Via blod:
S. aureus, Salmonella, Candida
• Ascenderende:

Rectum -> Perinæum -> (vagina) -> meatus urin. ext. ->

urethra -> blære -> ureter -> nyrepelvis -> nyre
E. coli, andre Enterobacteriaceae,
enterokokker mm
UTI route of infection

• Faecal-perineal-urethral route
PFGE of E. coli isolates
Urine Faeces

J. Urol 1997 157: 1127-1129
• Origin of E. coli in the normal flora unknown: is it
influenced by food?
ExPEC
• Possess pathogenic traits: virulence genes
• Virulence is a result of a cumulative effect
• Definition of ExPEC pathotypes
– Molecular definition proposed
(JID 2005 191: 1040-49)
– No distinct virulence profile
Virulence gene functions
Host tissue

2
5
Adhesins -
1
3
2

:
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9
E. coli
Toxins 1

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Iron uptake systems v
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Urinvejsinfektioner (UVI)

80-90% af UVI forårsages af E. coli:

ECOR fylogruppe-fordeling
• Extra-intestinale patogene
E. coli (ExPEC)

• Fylogruppe B2 (og D)

J
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5
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Schilling, Mulvey, and Hultgren
Structure and genetics of type 1 pili
JID 2001;183:S36-S40
Selective binding of FimH (A) and
antibodies to uroplakins (B) to the
umbrella cells of mouse urothelium.
Sections of mouse bladder were
incubated with biotinylated FimH-
FimC (A) or rabbit antibodies to total
uroplakins (B), and then with FITC-
conjugated streptoavidin or goat anti-
rabbit IgG. Nuclei were counterstained
with a blue Hoechst dye. Note the
similar staining of urothelial umbrella
cells by FimH-FimC and antibodies to
uroplakins.

Schilling, Mulvey, and Hultgren
JID 2001;183:S36-S40