Fraisse T, Lachaud L, Sotto A, Lavigne J-P, Cariou G, Boiteux J-P, Escaravage L, Coloby P, Bruyère F
Service des maladies infectieuses et tropicales, CHU de Nîmes, groupe hospitalo-universitaire Caremeau, place du Professeur-Robert- Debré, 30029 Nîmes, France.
Prog Urol. 2011 May;21(5):314-21. doi: 10.1016/j.purol.2011.02.004. Epub 2011 Apr 13.
The candiduria are frequently encountered in urology. We present the recommendations of the Infectious Diseases Committee of the French Association of Urology for diagnosis, treatment and monitoring of urinary tract infections. C. albicans is the most frequently isolated species, representing 60% of the isolates. Immunosuppression, diabetes mellitus, age extremes of life, the presence of catheters or procedures on the urinary tract are risk factors for Candida urinary tract infection. The candiduria is usually asymptomatic and does not need treatment. Only 4-14% of patients with candiduria have symptoms of urinary infection. It is necessary before choosing candiduria isolated on a first urinalysis to eliminate contamination by conducting a second harvest. In patients surveyed, the removal of the material allows the resolution of the candiduria nearly half the time and represents the first step of management. Oral fluconazole is the recommended treatment for cystitis (400 mg on day 1 and 200 mg daily for 7 to 14 days). In cases of pyelonephritis without associated candidemia, the first-line therapy is fluconazole (3-6 mg/kg/day) for 14 days or amphotericin B at a dose of 0.5 to 0.7 mg/kg/day with or not associated to flucytosine when potentially resistant strain (C. glabrata).
念珠菌尿在泌尿外科中经常遇到。我们介绍了法国泌尿外科学会传染病委员会关于尿路感染诊断、治疗和监测的建议。白色念珠菌是最常分离出的菌种，占分离株的60%。免疫抑制、糖尿病、极端年龄、存在导尿管或泌尿系统手术是念珠菌尿路感染的危险因素。念珠菌尿通常无症状，无需治疗。只有4%-14%的念珠菌尿患者有泌尿系统感染症状。在首次尿液分析中发现念珠菌尿后，在选择治疗前有必要通过再次采集尿液来排除污染。在接受调查的患者中，去除相关材料近半数情况下可使念珠菌尿得到缓解，这是管理的第一步。口服氟康唑是膀胱炎的推荐治疗药物（第1天400mg，之后每天200mg，持续7至14天）。对于无念珠菌血症的肾盂肾炎病例，一线治疗是氟康唑（3-6mg/kg/天）治疗14天，或者对于潜在耐药菌株（光滑念珠菌），使用剂量为0.5至0.7mg/kg/天的两性霉素B，可联合或不联合氟胞嘧啶。
