Jacobs L G, Skidmore E A, Freeman K, Lipschultz D, Fox N
Department of Medicine, Montefiore Medical Center, Bronx, New York 10467, USA.
Clin Infect Dis. 1996 Jan;22(1):30-5. doi: 10.1093/clinids/22.1.30.
Fungal urinary tract infections are increasingly prevalent in the elderly in acute and chronic care settings. This randomized trial compares the efficacy and safety of oral fluconazole with the efficacy and safety of bladder irrigation with amphotericin B for treatment of funguria (> or = 10,000 cfu/mL of urine) in 109 hospitalized elderly patients. A second treatment course was given for persistent funguria. Indwelling bladder catheters were present in 69% of the patients. While Candida albicans was the predominant isolate from catheterized patients, C. albicans, Candida tropicalis, and Torulopsis glabrata were recovered from noncatheterized patients. Two days after completion of treatment, funguria was eradicated in 96% of the patients treated with amphotericin B and 73% of those treated with fluconazole (P < .05). At 1 month after study enrollment, the mortality rate associated with all causes was greater among patients who were treated with amphotericin B bladder irrigation than among those who received oral fluconazole therapy (41% vs. 22%, respectively; P < .05); this finding suggests that local therapy may be associated with poorer survival. The proportion of patients without funguria at 1 month after study enrollment was similar in the two treatment groups (84%, amphotericin B group; 80%, fluconazole group). A few minor and mild adverse events occurred.
在急性和慢性护理环境中，真菌性尿路感染在老年人中越来越普遍。这项随机试验比较了口服氟康唑与两性霉素B膀胱冲洗治疗109例住院老年患者真菌尿（尿中菌落形成单位≥10,000 cfu/mL）的疗效和安全性。对持续性真菌尿患者给予第二个疗程的治疗。69%的患者留置了膀胱导管。虽然白色念珠菌是导尿患者的主要分离菌株，但非导尿患者中分离出了白色念珠菌、热带念珠菌和光滑念珠菌。治疗结束两天后，两性霉素B治疗的患者中有96%真菌尿被根除，氟康唑治疗的患者中有73%真菌尿被根除（P<0.05）。在研究入组1个月后，两性霉素B膀胱冲洗治疗的患者全因死亡率高于接受口服氟康唑治疗的患者（分别为41%和22%；P<0.05）；这一发现表明局部治疗可能与较差的生存率相关。两个治疗组在研究入组1个月后无真菌尿的患者比例相似（两性霉素B组为84%，氟康唑组为80%）。发生了一些轻微的不良事件。
