Carvalho M, Guimarães C M, Mayer J R, Bordignon G P, Queiroz-Telles F
Department of Internal Medicine, Section of Infectious Diseases and Laboratory of Mycology, Universidade Federal do Paraná, Brazil.
Braz J Infect Dis. 2001 Dec;5(6):313-8. doi: 10.1590/s1413-86702001000600004.
Fungal urinary tract infections are an increasing problem in hospitalized patients. Funguria may be a result of contamination of the urine specimen, colonization of hte urinary tract, or may be indicative of true invasive infection. In this study, we report the risk factors, clinical features, treatments and outcome in a group of 68 hospitalized patients (adults and children) with fungal isolates recovered from 103 urinary samples. Underlying medical conditions were present in most patients. In the pediatric group, urinary tract abnormalities (86%) and prematurity (19%)accounted for the majority of the cases. Diabetes mellitus (28%), nephrolithiasis, and benign prostatic hyperplasia were the most common diseases in adults. Indwelling urethral catheters were noted in 38% of the pediatric patients and in 43% of adults during hospitalization. Candida albicans strains were responsible for 97% and 75% of positive cultures in children and adults, respectively. Symptoms such as fever, dysuria, frequency and flank pain were generally absent in both groups. Fluconazole was the most frequent antifungal utilized (61%) in children and ketoconazole in the adult group (42%). Removing the urinary catheter was attempted in 6 pediatric patients (29%) and in only 8 adults (17%). One patient (4%) in the pediatric group died compared to 10 in the adult group (21%, p=0.04). Successful diagnosis and treatment of funguria depends on a clear understanding of the risk factors and awareness of fungal epidemiology.
真菌性尿路感染在住院患者中是一个日益严重的问题。真菌尿可能是尿液标本污染、尿路定植的结果，也可能表明存在真正的侵袭性感染。在本研究中，我们报告了从103份尿液样本中分离出真菌的68例住院患者（成人和儿童）的危险因素、临床特征、治疗方法及结果。大多数患者存在基础疾病。在儿科组中，尿路异常（86%）和早产（19%）占大多数病例。糖尿病（28%）、肾结石和良性前列腺增生是成人中最常见的疾病。住院期间，38%的儿科患者和43%的成人患者留置了尿道导管。白色念珠菌菌株分别占儿童和成人阳性培养物的97%和75%。两组患者通常都没有发热、排尿困难、尿频和侧腹痛等症状。氟康唑是儿童中最常用的抗真菌药物（61%），酮康唑在成人组中最常用（42%）。6例儿科患者（29%）和仅8例成人患者（17%）尝试拔除了尿管。儿科组有1例患者（4%）死亡，而成人组有10例（21%，p = 0.04）。成功诊断和治疗真菌尿取决于对危险因素的清晰理解以及对真菌流行病学的认识。
