García Bravo M, Aguado J M, Morales J M, Hayek M, Díaz González R, Gimeno Fernández C, Rodríguez Noriga A
Servicios de Microbiología, Hospital Doce de Octubre, Madrid.
Med Clin (Barc). 1995 Apr 22;104(15):561-4.
Corynebacterium urealyticum may produce severe urinary tract infections (UTI) in patients with renal transplantation (RT). The aim of this study was to define the prevalence, clinical spectrum and risk factors for the development of symptomatic UTI in RT receptors with bacteriuria by C. urealyticum.
The clinical data of RT patients with bacteriuria by C. urealyticum diagnosed in the Hospital Doce de Octubre in Madrid from January 1990 to September 1993 were retrospectively reviewed. The patients corresponded to two clearly differentiated periods. In the first, the presence of C. urealyticum was not actively sought in the urine sample while in the second an intentional search was carried out in all the RT with a selective culture medium containing different antibiotics, Tween-80 and urea to facilitate C. urealyticum identification and growth.
C. urealyticum was isolated in the urine of 46 patients (14% of the RT performed in the study period). In the first phase 16 cases were diagnosed with 30 being found in the second with the selective medium. Bacteriuria by C. urealyticum was symptomatic in 18 patients (39%): 12 acute cystitis, one encrusted cystitis (IC), and 5 encrusted pyelitis (IP). Of the symptomatic patients 39% had a history of prolonged vesical catheterization, 27% carried ureteral catheterization and 50% had undergone other urologic manipulations. The clinical consequences were important with development of obstructive uropathy and alteration in renal function (28%), need for surgery (33%) and graft loss (5.5%). All the C. urealyticum strains were sensitive to vancomycin and teicoplanin which were useful in the treatment although the most severe cases (IC, IP) required surgery.
The prevalence of UTI by Corynebacterium urealyticum is high in RT patients. Occasionally, these infections may have severe consequences, particularly in patients with a history of urologic manipulation, if early diagnosis is not performed and adequate antibiotic treatment given. A selective culture medium should be used to isolate C. urealyticum in RT patients.
解脲棒状杆菌可在肾移植（RT）患者中引发严重的尿路感染（UTI）。本研究旨在确定解脲棒状杆菌菌尿症的肾移植受者中症状性UTI的患病率、临床谱及危险因素。
回顾性分析1990年1月至1993年9月在马德里Doce de Octubre医院诊断为解脲棒状杆菌菌尿症的RT患者的临床资料。这些患者分为两个明显不同的时期。在第一个时期，尿液样本中未主动寻找解脲棒状杆菌，而在第二个时期，使用含有不同抗生素、吐温80和尿素的选择性培养基对所有RT患者进行有意筛查，以促进解脲棒状杆菌的鉴定和生长。
46例患者尿液中分离出解脲棒状杆菌（占研究期间进行的RT的14%）。第一阶段诊断出16例，第二阶段使用选择性培养基发现30例。18例患者（39%）的解脲棒状杆菌菌尿症有症状：12例急性膀胱炎，1例结痂性膀胱炎（IC），5例结痂性肾盂炎（IP）。有症状的患者中，39%有长期膀胱插管史，27%有输尿管插管，50%接受过其他泌尿外科手术。临床后果严重，出现梗阻性肾病和肾功能改变（28%）、需要手术（33%）以及移植肾丢失（5.5%）。所有解脲棒状杆菌菌株对万古霉素和替考拉宁敏感，这两种药物对治疗有效，尽管最严重的病例（IC、IP）需要手术。
肾移植患者中解脲棒状杆菌引起的UTI患病率很高。偶尔，这些感染可能会产生严重后果，特别是对于有泌尿外科手术史的患者，如果不进行早期诊断和给予充分的抗生素治疗。应使用选择性培养基在肾移植患者中分离解脲棒状杆菌。
