年轻男性泌尿系统感染
泌尿系统感染的年轻男性较少出现复杂性感染。[3]Lipsky BA, Schaberg DR. Managing urinary tract infections in men. Hosp Prac. 2000;35:53-59.http://www.ncbi.nlm.nih.gov/pubmed/10645989?tool=bestpractice.com[14]Krieger JN, Ross SO, Simonsen JM. Urinary tract infections in healthy university men. J Urol. 1993;149:1046-1048.http://www.ncbi.nlm.nih.gov/pubmed/8483206?tool=bestpractice.com[15]Lipsky BA. Prostatitis and urinary tract infection in men: what's new; what's true? Am J Med. 1999;106:327-334.http://www.ncbi.nlm.nih.gov/pubmed/10190383?tool=bestpractice.com在无复杂性泌尿系统感染的情况下,抗生素治疗更加有效且较少出现治疗失败。年轻男性预后良好。
老年男性泌尿系统感染
老年男性往往有复杂性泌尿系统感染。从泌尿系统消除细菌可能会更加困难,但是可以通过更长疗程的抗生素治疗来实现。[22]Smith JW, Jones SR, Reed WP, et al. Recurrent urinary tract infections in men. Ann Intern Med. 1979;91:544-548.http://www.ncbi.nlm.nih.gov/pubmed/384858?tool=bestpractice.com[57]Nicolle LE, Bjornson J, Harding GK, et al. Bacteriuria in elderly institutionalized men. N Engl J Med. 1983;309:1420-1425.http://www.ncbi.nlm.nih.gov/pubmed/6633618?tool=bestpractice.com感染复发的可能性仍然较高。风险存在于所有曾患泌尿系统感染的患者中,但复杂性泌尿系统感染的患者复发的风险更大,因为这类患者泌尿系统有潜在结构或功能异常的可能性。[1]Schaeffer AJ. Infections of the urinary tract. In: Walsh PC, ed. Campbells' urology, 8th ed. Philadelphia, PA: Saunders; 2002.[9]Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Am J Med. 2002;113(Suppl 1A):5S-13S.http://www.ncbi.nlm.nih.gov/pubmed/12113866?tool=bestpractice.com[22]Smith JW, Jones SR, Reed WP, et al. Recurrent urinary tract infections in men. Ann Intern Med. 1979;91:544-548.http://www.ncbi.nlm.nih.gov/pubmed/384858?tool=bestpractice.com此外,耐药性甚至多重耐药性的感染更常发生在这些患者中。[4]Ronald AR, Harding GK. Complicated urinary tract infections. Infect Dis Clin North Am. 1997;11:583-592.http://www.ncbi.nlm.nih.gov/pubmed/9378924?tool=bestpractice.com[50]Gupta K. Addressing antibiotic resistance. Am J Med. 2002;113(suppl 1A):29S-34S.http://www.ncbi.nlm.nih.gov/pubmed/12113869?tool=bestpractice.com
导尿管相关的泌尿系统感染
留置导尿管与发生泌尿系统感染的高风险相关。只要导尿管在,风险就一直存在。[26]Huang W, Wann S, Lin S, et al. Catheter-associated urinary tract infections in intensive care units can be reduced by prompting physicians to remove unnecessary catheters. Infect Control Hosp Epidemiol. 2004;25:974-978.http://www.ncbi.nlm.nih.gov/pubmed/15566033?tool=bestpractice.com[58]Leone M, Albanese J, Garnier F, et al. Risk factors for nosocomial catheter-associated urinary tract infection in a polyvalent intensive care unit. Intensive Care Med. 2003;29:1077-1080.http://www.ncbi.nlm.nih.gov/pubmed/12743682?tool=bestpractice.com导尿管也增加了菌血症发生的风险。[1]Schaeffer AJ. Infections of the urinary tract. In: Walsh PC, ed. Campbells' urology, 8th ed. Philadelphia, PA: Saunders; 2002.这类患者预后不佳,而且长期留置导尿管很可能与反复感染有关。
无症状性菌尿
无症状性菌尿的存在不会改变患者的发病率或病死率,除了患者需接受会破坏尿路构成组织的手术操作外。[7]Nicolle LE, Bradley S, Colgan R, et al. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis. 2005;40:643-654.http://cid.oxfordjournals.org/content/40/5/643.longhttp://www.ncbi.nlm.nih.gov/pubmed/15714408?tool=bestpractice.com后者可能有发展为菌血症或败血症的风险。