1. No category

Q\[F KMZEC OKPGFKH
\GZDGCP OK[R NXB QGMKSF KPZGD \B GRPMKS FC[ FEGCT GRTXKC
:GPM \GKNJKRDGZGB \GTZVF[ ,GRBXP GR\EGCTC .["EHP \GNCGSF
,Q\[ \GKZB[G OKPEGY OKKDGNGYRKD OKIG\KR ,FJKN[=KB ,FNXGJSKX
EKYV\ YI[P QDGZJSB ZETKF ,USGRC .(5) ["EH \TVGF \B \GZKCDP
.(6) ["EH N[ FKDGNGKHKVG\VC CG[I
OKNKXCGJYN OKYEKKIF \GCZ\F \B EEGTP QDGZJSBF QGPZGF
=F \B OKXKPIPF
.OKKTP KYEKKI N[ \GC[KK\F OKTRGPG YK\ZRC
=F ,OKNKXCGJYN QKB QDGZJSB ZETKFC
Z[VBPG FNGT YK\ZRC
.(1 OK[Z\) \KNJKRDGZGBF \KZKZC OKRDG\VGZGB \GIMGR
pH
pH
HZ NGBZ 'VGZV
\GKPGFKH \GNIPN FEKIKF NFRP
FNGVT ,YPTF KBGVZ HMZP
\GKPGFKHF \GNIPF \IB OF (["EH) Q\[F KMZEC OKPGFKH
.(1) FKPZJYCN Z\GKC FXGVRF FCKSF GH ,USGRC .Z\GKC \GXGVRF
FKZGKZJYC
QGKZFC ["EH
QRKB[ OK[RC F\GIKM[N FPGE QGKZFC OK[RC ["EH \GIKM[
FGCD SKJKZVRGNBKV HGIB OKKY QGKZFC[ BGF KZYKTF NECFF .QGKZFC
.Z\GK
OKZJZGBF NT WIN OZDR ,OIZF \NKED CYT ,QGKZFC F[KB NXB
OKPZGD (QGZJSDGZV ZYKTC) QGKZFF KRGPZGF \TV[F OT EIK FHG
\Z[VBPF \KJNJSKZVF \GNKTVF \[NIFNG OKRMVG[F \CIZFN
SKJKJSKXF KZYPP 50%=25%=C ,QMN .\GKNMN OKYEKKI N[ FZKEI
.SKJKZVRGNBKV \I\V\P
.LGPR NY[PC OKEGNKKG \GPEYGP \GEKNC ZG[Y QGKZFC ["EH
OKMGCKS TRGP ,KJPGJVPKSB GNKVB ,QGKZFC ["EHC KJGKCKJRB NGVKJ
.FNB
\ZMGSC ["EH
KNGIC Z\GK IKM[ ["EH OBF FNB[F KCDN \GTE KYGNKI OKPKKY
\ZMGS OT OK[R NXB \GIVN[ LMC \GYGNI QRKB \GTEF ONGB ,\ZMGS
.["EH N[ Z\K \GIKM[ \PKKY
\GVXN Q\KR QMNG ,Z\GK LCGSP BGF \ZMGS KNGIC ["EH ,USGRC
FHGZYR ,FKNMC \GSZGP OT OKNGI N[ Z\GK FNGED \GIKM[N FH CXPC
.'GMG \GNKVV N[
\KJPGJVPKSB FKZGKZJYC
Q\[ \GKCZ\ K\[C Z[BM \ZEDGP \KJPGJVPKSB FKZGKZJYC
105 OT YEKKI G\GB IPGX \GVGXZ
.Z\GK GB Y"PS / \GC[GP
BNN ,OK[RC \KJPGJVPKSB FKZGKZJYC[ GIKMGF \GCZ \GEGCT
N[ \GZ[VBF \B FZKCDP FRRKB ,Q\[F \MZTPC \GKTC
LZGX QKB ,QMN .OKZIB OKMGCKS GB OE WIN Z\K ,SKJKZVRGNBKV
5
23
Q\[F KNPZGR QVGBC .Q\[C OKYEKKI N[ \GIMGR BKF FKZGKZJYC
EIGKPC ,KNZ\ZGBKZVF ZGHKBC OKYEKKI N[ \GC[KK\F JTPN ,ZYT
.OK[RC
JTPN ,OKZCD \PGTN OK[RC Z\GK FIKM[ FKZGKZJYCF :\GIKM[
,(1% ET) OKRCC Z\GK FFGCD F\GIKM[ FC ,FRG[BZF OKKIF \R[C
.\GRC NXBP 4 KV FFGCD OKENGPF OKPGPF \GIKM[ OKRC NXB[ QGGKM
,FR[ NKD KZIB .OKRCC FKZGKZJYCF \GIKM[ \B FEKZGP FNKPF \KZC
\GIKM[F \GZKTX OK[RCG ZVS \KC NKDC ;\GRC NXB Z\GK FIKM[ BKF
,\BH \PGTN .20% NTP = ZCTPF NKD ZIBN OK[RCG ,10%=5%=N FTKDP
40 NKD NTPG ,0% JTPM BGF 40 NKD ET FKZGKZJYCF HGIB OKZCDC
.10%=M
TKDP OKKZJBKZD OKNGI K\C GB \GCB K\CC OKBXPRF OK[K[YC
.(3=2) 50%=30%=N FKZGKZJYCF ZGTK[
FKDGNGKHKVG\V
N[ FKKSGNMGB CZYC .OK[RC EGBP FIKM[ FNIP BKF ["EH
.OK[RC \G[IZ\P \GKZGKZJYCF LSP 90%=80%=M ,OKBKZC OK[RB
QP O\KKNT BKF Q\[F KMZEN OKYEKKI \ZKEI N[ FXGVRF LZEF
,OKKTP KYEKKI N[ KZYKTF ZDBPF .Q\[F \KIGVN[ LG\N YK\ZRF
.SDF KTPF BGF ,E. coli ZYKTC
\GZKTX OK[R
QGMKS KPZGD
.["EH \TVGFN QKP KSIK OGKY QKC Z[Y GIKMGF \GCZ \GEGCT
KSIK \GPKKYP QRKB[ OK[RC ["EH \GIKM[[ GBZF (6) GKZCIG
QKP KSIK \GPKKYP[ FNBC FR[N 52/100 \PGTN ,FR[N 7/100 BKF QKP
.(4)
Z\K \GIKM[N BGF OD ZG[Y FTKRP KTXPBM FPDZVBKEC [GPK[F
,9 NGRKSYGRGP GPM OKKEKXKJPZVS OKZPGIC [GPK[ UBG ,["EHC
KNNGIP N[ \GC[KK\F Z[VBPG YK\ZRF N[ FZGNVF \B FR[P
.Q\[F KMZEC OKPGFKH
Dennis
\GKNHGBVGRPJSGV OK[R
QGMKS KPZGD
OKZEDGP ["EHN QGMKSF KPZGD QNXB[ ,\GZKTX OK[RN EGDKRC
.B[GRF \B GYEC[ \GEGCT N[ QJY ZVSP [K \GZDGCP OK[RC ,CJKF
\GKPGFKH \GNIP
ZXY NGVKJ
Z[BM NKTK GRKF ,OKPK 3 L[PN GB KPTV=EI ,ZXY NGVKJ
OK[ZVGP OF[G ,KJKB Q\[F KMZEC OKKGRKV[ OKZK[M\C OK[P\[P
.OKPK ZVSP N[ FVGY\C Q\[C
O\GNKTK[ OKEKIKF OKZK[M\F OF OKRGNGRKGGYG NGHSYGPKZJGY
NGHSYGPKZJGYN \GEKPTF HGIB QFC[ \GRKEPC .ZXY NGVKJC FIMGF
.["EHC NGVKJN FZKIC ZK[M\M FVGZ\F \C[IR ,10% NT FNGT FRKB
GPM ,30% NT FNGT NGHSYGPKZJGYN \GEKPTF HGIB FC[ FRKEPC
.KZKVPB NGVKJC \XNPGP FRKB GH FVGZ\ ,WZBC
\GIVN O\GB \\N [K LB ,OKNKTK QKJREGZYPG OJYN=FJC KZK[M\
.FGCD KGVKZ HGIB IKJCFN \RP NT OKPK 5 L[PC
NKDZ NGVKJ
DGSN Z[Y KNC ,OKMGCKS OT ["EHC WNPGPF NGVKJF L[P
.OKPK 7 BGF ,ZK[M\F
LGZB NGVKJ
L[PN KJGKCKJRB NGVKJ \\N [K ,SKJKZVRGNBKV N[ FZYP NMC
\\N QKB GNB OKZYPC .FVGZ\F DGSN Z[Y BNN ,OKPK 14=M
.QKJREGZYP GB QKXKPGVSGV
TRGP NGVKJ
NGY[N OGYP [K ,Z\GK GB FR[C ["EH KTGZKB 3 OT F[KB NXB
NMC NVJN Q\KR ,OKTGZKB 2=1 [K OB .TRGP KJGKCKJRB NGVKJ Q\P
.EZVRC TGZKB
ZK[M\ N[ QJY QGRKP Q\PC ,TRGPF KJGKCKJRBF NGVKJF \ZJP
OKYEKKIF "\GYCEKF" TGRPN FRKF ,\M[GPP FVGY\N KJGKCKJRB
.["EH TGRPN LMG ,\KNJKRDGZGBF \KZKZC
ZKCSFNG QGC[IC \IYN [K LB ,Z\GKC OKNKTK GNB OKNGVKJ
ORKB OF ONGB ,O\GB \NCYP FNGIF EGT NM OKNKTK OF[ \GNGIN
BKF ,OFC [P\[FN FYKSVP F[KBF[M .FNIPF LNFP \B OKR[P
OD ,FYKJGKCKJRB N[ L[GPP Q\P[ ZGMHN [K .["EHN FVG[I CG[
\ZKXKG KBGGNF \GTVG\ \GZC\SF \B ZKCDP ,OKMGPR OKRGRKPC
.\GEKPT
OKKNKN[ OZD OKD\P EDR CIZ OGZJYVS NTC KJGKCKJRB ZK[M\ NM
.NKTK BGF
FZGNVF \B FR[P BGF QKB[ QGGKM ,QKJREGZYP \\N OKVKETP GRB
,OKEKPT OKYEKKI \ZKXKN OZGD GRKBG JTPM QMNG ,KTPFG YK\ZRF N[
OKPTV 3 GB FNKN NM NGVKJ \\N Q\KR .SKJKRKDG FEKERY \TVGFN GB
\KNCJ \\N WNPGP \GZKTX OK[RC .FR[ KXI L[PN TGC[C
.QKP KSIK OGKY ZIBN FYKJGKCKJRB
EGBP NKTKM IMGF KYK\ZR=LG\ QDGZJSB Q\P ,\GZDGCP OK[RC
.KVGZJB SKJKRKDGGN OKZG[YF OKPGJVPKS \NYFCG ["EH \TKRPC
OKZCDC ["EH
40 NKD ET OKZCDC .OK[R \PGTN OKZCDC \GIV IKM[ ["EH ,ZGPBM
.FZKER FNIP BGF ["EH ,FR[
\KRGPZTF ."OKMGCKS OT OGFKH"M EKP\ C[IR OKZCDC ["EH
\GKPGFKH \GNIP
,FRKY\ Q\[ \MZTP OT OK[RC \KJPGJVPKSB FKZGKZJYCC NVJN
(7) .QGSKI KBMGEP OKNGIG OKR[ 5 NKD ET OKENK ,QGKZFC OK[R JTPN
SKJKZ\ZGB = SKJKJSKX :\GRG\I\F ["EH
OKZYPC .\GZKTX OK[RC EIGKPC ,Z\GKC FIKM[ FNIPC ZCGEP
GB (SKJKJSKX) Q\[F \KIGVN[ \KZKZN OKYCER OKYEKKIF GNB
.(SKJKZ\ZGB) FMVG[N
Q\PC \GVKM\G \GVKIE ,FCKZX :OF OKKZYKTF OKPGJVPKSF
OGZDN FKG[T FCGZP FKK\[ .OKKR\GPC OKCBM GB OGI BNN ,Q\[F
.OKZYPFP 20%=M N[ KDGNGKZJYCG KRKNY KGVKZN
.E. coli BGF OKZYPF N[ 80%=C ["EHN OZGDF IKM[F YEKKIF
N[ OKPGJVPKSF NT NYFN \RP NT F[TPN Q\KR KJGKCKJRB NGVKJ
["EH KGVKZN GBKCK ,ZXY KJGKCKJRB SZGYG FCGZP FKK\[ .FNIPF
.OKZYPF N[ 90%=P Z\GKC
SKJKZVRGNBKV :\GRGKNTF ["EH
ZGHKBC C[KK\FNG FKNMN \GNTN OKIKNXP OKYEKKI GNB OKZYPC
\GNGMK ,\GZKFPC GC OKNVJPG OGFKHF \B OKRICBP BN OB .FNGEPF
FGGNP SKSVS N[ \KRKNY FRGP\G \GK\KNM=LG\ \GSZGP I\V\FN
N[ \GZ[VB OT SKHGJKXGYKGNG ,FKEZYKMJ ,\ZGPZPX ,FGCD OGIC
.\GGPG KJVS ONF ,\K\MZTP=CZ \GCZGTP
,OKPK 14 L[PN \GIVN ,KJGKCKJRB NGVKJC LZGX [K GNB OKZYPC
.KRKNYF QCXPN OB\FC \GNGIF HGV[B NGY[N [KG
OKMGCKS BNN ["EH
Q\[ \MZTP \GNTC ,\GBKZC ,\GZKTX OK[R NXB ["EHC ZCGEP
.FRKY\
OKMGCKS OT ["EH
\KRGSKIF \MZTPC \GTDGV[ TYZ \GNIP OT OK[RC ZCGEP
\MZTPC \GTZVF \GPKKY QNXB[ \GNGI GB ,('GMG OKEKBGZJS ,\ZMGS)
.(SKHGZVRGZEKF SYGNVZ ,OKRCB) Q\[F
N[C ,GH FXGCYC \GNNMR ["EH OT ZCTPF NKD ZIBN OK[R
QGN[KM N[ OKFGCD OKHGIBG OKZHGI OKTGZKB N[ FFGCDF \GIKM[F
FXGCYC OKNNMR OKR[ 6 NKD ET OKENKG OKZCD OD .KJGKCKJRB NGVKJC
.GH
NGVKJ
TY[PC FKZGKVG ,OKMGCKS BNN ["EHN E[I OT FZKTX F[KB NXB
.Q\[ \KCZ\ TXCN LZGX BNN NVJN Q\KR ,Q\[F
FNKFYC ["EH N[ FKDGNGKCGZYKP
KRVN KZKVPB QVGBC Q\KR ["EHC NGVKJF OKZYPF CGZCG \GKF
\GDNV\F \B ZKMFN EGBP CG[I ,\GKCZ\N \GYKECF \GCG[\ \NCY
.GRZGHKBC OKNNGIPF \G[KDZG
\BXPR KR[ OGYPCG ,FNKFYC ["EHC IKM[F YEKKIF BGF E. coli
.OKZKER ,OKYGYGZJRB NNGM ,OKKCGKI OZD OKYGY .FNBKSCNY
24
C
M
Y
CM
MY
CY CMY
K
NGVKJ
\KJGKCKJRB FVGZ\ NGNMN CKKI \KYEKKI SKJKJJSGZVC NGVKJF
OT FVGZ\G OKKNKN[ OZD OKD\P EDR ZYKTC ,CIZ OGZJYVS \NTC
.\KRGPZTN FCGJ FZKEI
FZKEI Z[GM KNTC OF OKRGNGRKGGYG NGHSYGJPVNGS = OKZVGJPKZJ
.\KRGPZTN CGJ
FNKTK FZGXC OKHMZ\PG OKZEGI ORKB OKPJYN BJC ,\BH \PGTN
BGF WNPGPF NGVKJF ,[KDZ YEKKIC ZCGEP OB ,QMN .FJGNCC
[K ,EKPT YEKKIC ZCGEP Z[BM LB ,NGHSYGJPVNGS = OKZVGJPKZJ
.OKRGNGRKGGYC NVJN
ZJ\Y OT FNGIC ["EH
\SRMFP TRPKFN BGF FKZGKZJYC TGRPN \RP NT KGXZF ZCEF
.KZ[VBF OEYFC G\BXGF NGY[N [K ,Q\KR GRKB ZCEF OB .ZJ\Y
OKMZE [VIN [K ,ZJ\YF \BXGF Z[VBP GRKB FNGIF CXP OB
.FKZGKZJYCF \GIKM[ \RJYFN
\MZTP Z[BM ,Q\[F \KIGVN[C ,"KNGV" = TGCY ZJ\Y OT FNGIC
ZCGEP Z[BMG ,OKPK 7=5 LG\ FKZGKZJYC TKVG\ ,FIG\V UGSKBF
.\GTGC[ 4=3 ZIBN YZ ,FZGDS \MZTPC
TGCY ZJ\Y OT FNGI NXB FKZGKZJYC TGRPN LZE \PKKY BN
.\GK\VGY\ Q\[ \GKCZ\ \IYN QKB ,QM GPM .Q\[F \KIGVN[C
,LMN FCKS OKBXGP GRRKBG OGI I\VP TGCY ZJ\Y OT FNGI Z[BM
ZJ\YFP \KCZ\N Q\[ IGN[N ,GVKNIFN ,ZJ\YF \B BKXGFN [K
BXPRF ZJ\YP Q\[ \IKN[ .GH FYKECP FCG[\N SIKK\FNG [EIF
,K\KPBF CXPF \B \VY[P FRRKB \KIGVN[F LG\C \M[GPP FVGY\
IZMFC ORKB[ ,OKCZ OKYEKKIC IJ[F KRV NT FSGMP ZJ\YFG \GKF
.OGFKHN OKKBZIB
\KJRJKPZJRKB FKXHKZJ\Y
.\KRDGZKGR \KIGVN[ KNTCN GB OKDNVZV OKNGIN \XNPGP GH FJK[
OKPTV 6=4=M \KIGVN[F \GRYGZ\F LZGXN ZJ\Y \SRMFC ZCGEP
.FKZGKZJYC \TVGFN \GZ[VBF \B QKJYFN Q\KR LM ,OGKC
ONXB[ OKNGIC FKZGKZJYC TRGP KJGKCKJRB NGVKJ[ FIMGF QKB
.\KJRJKPZJRKB FKXHKZJ\Y OKTXCP
\GZGYP
1.
Patton JP, Nash DB, Abrutyn E. Urinary tract infection:
N[C GB ,FNIPF N[ FKDGNGKHKVG\VC KHMZP EKYV\ \YI[P
FECGTF CYT GB Q\[F Q\PC FPKSIN \PZGD[ FKVGZJZVKF
(8) .SKJKJJSGZVN OGZDNG OFEHFN FJGR FPXT FJGNCF[
SKJKJJSGZV
.SKJKJJSGZV N[ TGZKB \IB OTV \GIVN ZGCTK OKZCDFP 50%=M
:\GKZYKT \GXGCY TCZBN OYNIN Q\KR
FVKZI \KYEKKI SKJKJJSGZV
.\KRGZM \KYEKKI SKJKJJSGZV
.\KYEKKI BN \KRGZM SKJKJJSGZV
.FKRKEJSGZV GB OKKRGZM OKCBM
.1
.2
.3
.4
FVKZI \KYEKKI SKJKJJSGZV
.SKJKJJSGZVF KZYP LSP 5%=3%=M FGGFP FVKZI SKJKJJSGZV
FRGP\F ;OKR[ 60=40 KRC OKNGIC CGZN \ZBG\P[ FNIPC ZCGEP
\ZGPZPX ,FGCD OGI OT ,\KPGB\V ,FEI FNIP N[ BKF \KRKNYF
.OKIKM[F OKYEKKIF OF OKKNKN[ OZD OKD\P .Q\[ Q\PC \GTZVFG
TRPKFN [K ;OEF \GKCZ\ OD OK\KTNG \GKCGKI Q\[F \GKCZ\ ,CGZN
N[ KRDGJPF ZGHKVN OGZDN FNGNT BKF[ QGGKM \KNJYZ FYKEC TXCNP
.OKYEKKI
\KRGZM \KYEKKI SKJKJJSGZV
Z\GK FIKM[ FNIP BKF \KRGZM \KYEKKI SKJKJJSGZV
\ZDGCP FKKSGNMGBC NNM LZEC ,OKNGIF N[ 10%=5%=C FTKVGPF
FXGCYF N[ FNBN OKPGE OKNNGIPF .FR[ 80=60 KRC ,Z\GK
FRGP\F LB ,OGI BNN CGZN ,Q\[ Q\PC \GTZVF [K .\PEGYF
\KRGPZT \BXPR \KNJYZ FYKECC .\ZTGS FRKB QBM \KRKNYF
.F[KDZG \NEDGP
\KRGZM \KYEKKI BN SKJKJJSGZV
OKNGIFP 50%=30%=M ,Z\GK OKZKTX OKNGI OKMKK\[P GH FXGCYN
Q\[F \GKCZ\ LB ,\PEGYF FXGCYF N[ GHN FPGE FYKRKNYF .FXGCYC
.\GZYT TZHFG
OKNNGIP OKZBG\P OK\KTN .FTGEK FRKB FNIPF N[ FKDGNGKJBF
.OKVKDR GB FPSNVBZGB ,FPSNVGYKP ,FKEKPNY GPM
economic consideration. Med Clin North Am 1991;75:495513.
2.
Schaeffer AJ, Urinary tract infection in men - State of the art.
3.
Romano JM, Kaye D. UTI in the elderly: common yet
Infection 1994;22 (Suppl. 1):19-21.
atypical. Geriatrics 1981;36:113-5.
(.\MZTPC OKZGP[ \GZGYPF ZB[)
\GKPGFKH \GNIP
FKRKEJSGZV GB OKKRGZM OKCBM
OKNCGS ,FR[ 40 =30 KRC ,OKZKTXF OK[RBFP 40 %=20 %
O NX B Q KB LB , FR G \I \ QJ CC O K CBMP G Q \[ Q \P C \ GT ZVF P
Q \[ F \G KC Z\G FK ZG K V Q KB ZPG N M ,K \Y NE LK N F\ N G B O G F KH N \G ET
. \GZY T TZHFG
26