肾结石患者尿路真菌感染的临床防治研究

The clinical study of prevention and treatment of urinary fungal infections in patients with kidney stones

目的研究肾结石患者尿路真菌感染诱因以及真菌分布特点,以降低感染率。方法将2009年12月-2013年12月就诊的643例复杂性肾结石患者的中段尿进行培养,根据是否并发感染将复杂性肾结石患者分为真菌感染组32例和非感染组611例,对真菌感染的患者给予微创经皮肾镜取石术(MPCNL)治疗,采集中段尿进行真菌药敏试验,分析导致尿路感染的相关因素。结果 643例复杂性肾结石患者发生真菌尿路感染32例,感染率4.98%,送检标本检出白色假丝酵母菌23株占71.88%,隐球酵母菌属9株占28.12%;32例真菌尿路感染患者均有反复长期使用广谱抗菌药物病史;术后复杂性结石完全清除率为93.75%,疗效明显,术后肾功能得到不同程度的恢复,患者未出现大出血和真菌败血症等并发症。结论复杂性肾结石易并发真菌感染,应合理使用广谱抗菌药物,缩短患者术后留置导管的时间,对于复杂性结石并发真菌感染的患者采用MPCNL治疗,其疗效明显,具有安全性高、并发症少的特点。

OBJECTIVE To explore the etiology and the strain distribution of urinary fungal infections in patients with kidney stones,in order to reduce the rate of infections.METHODS The mid-stream urine culture was conducted in 643 cases of patients with complex kidney stones from Dec.2009 to Dec.2013.According to the concurrency of infections,the patients with complex kidney stones were divided into the fungal infection group（n=32）and the non-infection group（n=611）.The mini-percutaneous nephrolithotomy（MPCNL）was performed for patients with complex kidney stones combined with fungal infections,and the mid-stream urine was collected for drug sensitive test of fungi to analyze the related factors of urinary infections.RESULTS Of 643 patients with complex kidney stones,4.98%（32cases）were presented with fungal infections,including 23 Candida albicans（71.88%）and 9 Cryptococcus neoformans（28.12%）.All the 32 patients had long-term repeated use of broad-spectrum antibiotics.The complete clearance rate of stones was 93.75%after operation which was effective.After treatment,patients＇ renal function was recovered in different degrees,and no complications such as bleeding and fungal septicemia occurred.CONCLUSIONFor the patients with complex kidney stones combined with fungal infections,clinicians should reasonably use broad-spectrum antibiotics and shorten the time of indwelling catheter.The curative effect of MPCNL is obvious with high safety and less complications.