Takeuchi H, Okada Y, Yoshida O, Arai Y, Tomoyoshi T
Department of Urology, Faculty of Medicine, Kyoto University.
Hinyokika Kiyo. 1989 May;35(5):749-54.
We investigated 158 cases of urinary stones (infection stones 56, metabolic stones 102) with special reference to pyuria, bacteriuria, stone culture and urease activities of isolated bacteria. Abacterial pyuria was noted in 9 out of 49 (18%) infection stones and in 53 of 77 (69%) metabolic stones. Bacteriuria was noted in 79% of the infection stones and 26% of the metabolic stones. Sixty-seven percent of the infection stones were infected with mainly urea splitting bacteria such as Proteus mirabilis and Staphylococcus. Twenty-three percent of metabolic stones were also infected. Though E. coli, a non-urea splitting bacteria, was isolated most frequently from metabolic stones, urease positive Staphylococcus and Pseudomonas were also isolated. Bacteria within stones could be predicted on the basis of urine culture results of only 20 of 41 infection stones and 8 of 24 metabolic stones. These facts are useful for selection of some antibiotics in the treatment of urinary tract infections associated with urinary calculi. Urinary infections of urea splitting bacteria in infection stones are thought to be initial factors of stone formation and those of non-urea splitting bacteria are to be superimposed. However, urea splitting bacteria in metabolic stones may convert them into infection stones in future.
我们对158例尿路结石患者（感染性结石56例，代谢性结石102例）进行了研究，特别关注脓尿、菌尿、结石培养以及分离细菌的脲酶活性。在49例感染性结石中有9例（18%）出现无菌性脓尿，在77例代谢性结石中有53例（69%）出现无菌性脓尿。79%的感染性结石和26%的代谢性结石中发现菌尿。67%的感染性结石主要感染了能分解尿素的细菌，如奇异变形杆菌和葡萄球菌。23%的代谢性结石也受到感染。虽然从代谢性结石中最常分离出的是非尿素分解菌大肠杆菌，但也分离出了脲酶阳性的葡萄球菌和假单胞菌。仅根据41例感染性结石中20例以及24例代谢性结石中8例的尿液培养结果，就能预测结石内的细菌。这些事实有助于在治疗与尿路结石相关的尿路感染时选择某些抗生素。感染性结石中尿素分解菌引起的尿路感染被认为是结石形成的初始因素，而非尿素分解菌引起的尿路感染则是叠加因素。然而，代谢性结石中的尿素分解菌未来可能会将其转化为感染性结石。
