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» INFECTII URINARE


INFECTII URINARE




INFECTII URINARE

I. Diagnostic

ex. sumar urina

hemoleucograma




VSH, CRP

urocultura

hemocultura

identificare factori favorizanti

ecografie renala si pelvina

glicemie

sarcina (test sarcina, ecografie, consult ginecologic)

obstacol (UIV)

II. Tratament in functie de forma clinica

Forma clinica

Etiologie

Tratament

de prima intentie

Alternative

terapeutice

Durata

tratament

PNA necomplicata severa

BGN (E. coli,

Proteus,

Klebsiella)

Staphilococcus

saprophyticus

Enterococ

AminoPen / AminoPen+

+inhib.βlactamaza

+Aminoglicozid

Fluorochinolone

Cefalosporine gen III / gen. IV

±aminoglicozid

Carbapeneme

14 zile*

PNA complicata severa

BGN (E. coli,

Proteus,

Klebsiella)

Staphilococcus

saprophyticus

Enterococ

Piocianic

Serratia

Βlactamina antipiocianic +inhib.βlactamaza

( Timentin / Tazocin )

Cefalosporine gen III

(antipiocianic )

± aminoglicozid

Carbapeneme

14 - 21 zile *

PNA la gravida

BGN (E. coli,

Proteus,

Klebsiella)

Staphilococcus

saprophyticus

Enterococ

AminoPen / AminoPen+

+inhib.βlactamaza

Cefalosporine gen III / gen. IV

14 zile*

ITU

Nosocomiala

BGN (E. coli,

Proteus,

Klebsiella)

Piocianic

Acinetobacter

Fungi

Βlactamina antipiocianic

+inhib.βlactamaza

( Timentin / Tazocin )

+ Fluorochinolone /

aminoglicozid

antifungic (Fluconazol)

Cefalosporine gen III

(antipiocianic )

+ Fluorochinolone /

aminoglicozid

Carbapeneme

Voriconazol / Caspofungin



14 - 21 zile *

* tratament iv pana are minim 48 ore de afebrilitate, apoi poate primi tratament po (AminoPen+inhib.βlactamaza sau Fluorochinolone)

Forma clinica

Etiologie

Tratament

de prima intentie

Alternative

Terapeutice

Durata

tratament

Abces intrarenal cortical

Staphilococcus

aureus

-meti sensibil

Oxaclina + aminoglicozid

Fluorochinolone

10 - 14 zile inj.

apoi 2 - 4 sapt

trat. po

Staphilococcus

aureus

-meti rezistent

Glicopeptide

Linezolid

Carbapeneme

10 - 14 zile

Abces intrarenal

cortico-medular*

Staphilococcus

aureus

BGN

Βlactamina +inhib.βlactamaza

± Fluorochinolone /

aminoglicozid

Fluorochinolone inj

Cefalosporine gen III

± aminoglicozid

Carbapeneme

10 - 14 zile inj.

apoi 2 - 4 sapt

trat. po

*Drenaj chirurgical percutan (in caz de esec al terapiei cu antibiotice / abces mare / urosepsis / uropatie obstructiva )

III. Supravegherea eficientei terapiei

- afebrilitate dupa 48 ore de tratament antibiotic - continua tratamentul

- febra dupa 48 ore de tratament antibiotic - repeta urocultura

+ antibiograma

- ecografie

- consult urologic

- UIV

IV. Tratament asociat in ITU

hidratare 2-3 l lichide/zi ( solutii cristaloide, solutii macromoleculare in soc, ser glucozat, saruri de rehidratare orala)

AINS

HHC (urosepsis, soc)

Antiseptice urinare

Combaterea constipatiei (laxative)

V. Durata spitalizarii

ITU necomplicate = 7-10 zile

ITU complicate = 10 - 21 zile








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