Retrograde bacterial infection

Introduction The so-called retrograde bacterial infection means that the bacteria enter the urinary system from the urethral orifice, through the urethra to the bladder and even into the kidney or accessory testis, the prostate. Most of the bacteria are from the intestines, especially E. coli. Outpatient urinary tract patients are mostly female (male: female about 1:8), because women have short urethra (about 3-4cm), and the opening is quite close to the vagina and anus, so bacteria are prone to poor hygiene or sexuality. Acting into the urinary system causes infection.

Cause

Poor health habits and sexual behavior, physical resistance decreased. When the body's immune function declines, it can't fully exert its phagocytosis and kill bacteria. Even if the amount of invading bacteria is small, the pathogenicity is not strong, it can cause infection; the iatrogenic infection caused by the conditional pathogens is gradually increasing. Bacterial factors are mainly related to the virulence and quantity of pathogens. Pathogenic bacteria with strong virulence or a large number enter the body, which is more likely to cause sepsis.

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Related inspection

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Ask the relevant medical history carefully. Perform physical examinations, and at the same time, it is necessary to carry out bacterial culture experiments, and combine the relevant equipment examinations to make the most appropriate diagnosis after considering the symptoms of the patients. Principles for collection and inspection of pathogen specimens:

1. Different materials: According to the distribution and discharge of different pathogenic bacteria in the body, take different specimens. Try to take the material of obvious parts of the lesion.

2. Strict aseptic operation to avoid contamination of specimens and aseptic materials to prevent contamination of bacteria.

3. Proper handling: Specimen collection should be before the use of antibacterial drugs.

4. Send the test as soon as possible: the specimen must be fresh, and sent to the test as soon as possible after collection. Most of the bacteria can be refrigerated, and the stool specimen should be added with glycerol buffered saline preservation solution.

5. Make a mark and fill the test form.

Differential diagnosis

The diagnosis should be differentiated from the following symptoms:

1. Urethritis: In women, urethritis and vaginitis are the causes of most urinary tract symptoms when the urine specimen culture is negative. Candida albicans, trichomonas vaginitis or bacterial vaginitis can cause dysuria when urine flows to the inflamed labia. Although mainly due to dysuria, vaginal discharge, odor and sexual intercourse difficulties also occur in most women. Sexually transmitted diseases such as Chlamydia trachomatis, Neisseria gonorrhoeae or herpes simplex virus cause mild symptoms, slow onset, and no other urinary tract symptoms other than dysuria. Hematuria is often absent in mid-stage urine analysis.

2. Cystitis: There is a strong suggestion of bacterial cystitis in the gross hematuria. Urine microscopy (bacteria and leukocytes) and urine culture can confirm the diagnosis. Almost all female patients have pyuria, up to 50% have microscopic hematuria, and mid-stage urine culture specimens generally show pathogenic bacteria, but about 30% of patients have similar symptoms of cystitis without obvious bacteriuria (colony forming units)

3.: Prostatitis Because acute cystitis often accompanied by acute prostatitis, it is often confirmed that bacterial pathogens can be confirmed by urine excretion through the bladder. Because of the risk of causing bacteremia, doctors should not massage an acutely inflamed prostate until a suitable antibacterial agent reaches a sufficient blood level. Chronic prostatitis may be more hidden. Usually only manifested as recurrent bacteriuria or with hypothermia and back or pelvic discomfort. Chronic prostatitis is the most common cause of recurrent symptomatic urinary tract infections in men because infections continue to enter the bladder. A positive diagnosis of prostate massage fluid can confirm the diagnosis. The patient was urinated after cleaning the area around the urethra. The first 5-10 ml (VB1) and middle specimen (VB2) were used for quantitative culture. The patient stops urinating before the bladder is empty and performs a prostate massage. Any extruded prostate exudates and the first 5-10 ml of urine (VB3) that were subsequently expelled were cultured. The test results were interpreted as suspected chronic prostatitis when bladder urine (VB2) required 12 WBC/high power field. Urine or extruded prostate secretion culture is almost always positive in chronic prostatitis, but negative culture cannot rule out diagnosis.

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