Department of Infectious Diseases, Barwon Health, Geelong, Victoria, Australia.
Department of Infectious Diseases, Alfred Hospital, Melbourne, Victoria, Australia.
BMC Infect Dis. 2021 Mar 20;21(1):284. doi: 10.1186/s12879-021-05982-3.
Sodium-glucose co-transporter 2 (SGLT2) inhibitors are novel hypoglycemic agents which reduce reabsorption of glucose at the renal proximal tubule, resulting in significant glycosuria and increased risk of genital mycotic infections (GMI). These infections are typically not severe as reported in large systematic reviews and meta-analyses of the medications. These reviews have also demonstrated significant cardiovascular benefits through other mechanisms of action, making them attractive options for the management of Type 2 diabetes mellitus (T2DM). We present two cases with underlying abnormalities of the urogenital tract in which the GMI were complicated and necessitated cessation of the SGLT2 inhibitor.
Both cases are patients with T2DM on empagliflozin, an SGLT2 inhibitor. The first case is a 64 year old man with Candida albicans balanitis and candidemia who was found to have an obstructing renal calculus and prostatic abscess requiring operative management. The second case describes a 72 year old man with Candida glabrata candidemia who was found to have prostatomegaly, balanitis xerotica obliterans with significant urethral stricture and bladder diverticulae. His treatment was more complex due to fluconazole resistance and concerns about urinary tract penetration of other antifungals. Both patients recovered following prolonged courses of antifungal therapy and in both cases the SGLT2 inhibitor was ceased.
Despite their cardiovascular benefits, SGLT2 inhibitors can be associated with complicated fungal infections including candidemia and patients with anatomical abnormalities of the urogenital tract may be more susceptible to these infections as demonstrated in these cases. Clinicians should be aware of their mechanism of action and associated risk of infection and prior to prescription, assessment of urogenital anatomical abnormalities should be performed to identify patients who may be at risk of complicated infection.
钠-葡萄糖协同转运蛋白 2（SGLT2）抑制剂是一种新型的降血糖药物，可减少肾脏近端小管对葡萄糖的重吸收，导致大量糖尿和增加生殖器真菌感染（GMI）的风险。这些感染通常不像大型系统评价和药物荟萃分析报告的那样严重。这些综述还通过其他作用机制证明了显著的心血管益处，使其成为 2 型糖尿病（T2DM）管理的有吸引力的选择。我们报告了两例存在尿路生殖道异常的病例，这两例 GMI 都很复杂，需要停止 SGLT2 抑制剂的治疗。
两例患者均为服用 SGLT2 抑制剂恩格列净的 T2DM 患者。第一例是一名 64 岁的男性，患有白色念珠菌性龟头炎和念珠菌血症，发现有阻塞性肾结石和前列腺脓肿，需要手术治疗。第二例描述了一名 72 岁的男性，患有光滑念珠菌血症，发现前列腺肿大、干燥性龟头炎和严重的尿道狭窄和膀胱憩室。由于氟康唑耐药和对其他抗真菌药物在泌尿道穿透性的担忧，他的治疗更加复杂。两位患者在接受长期抗真菌治疗后均康复，且在这两例中，SGLT2 抑制剂均被停用。
尽管 SGLT2 抑制剂具有心血管益处，但它们可能与复杂的真菌感染有关，包括念珠菌血症，且尿路生殖道解剖异常的患者可能更容易受到这些感染的影响，正如这两例病例所证明的那样。临床医生应了解其作用机制和相关感染风险，在处方前，应评估尿路生殖道解剖异常，以识别可能有复杂感染风险的患者。
