尿路真菌症の臨床的研究 - 患者背景因子と分離真菌の現状に関する検討 -

Abstract

症例は16施設の男97例, 女55例の計152例, 平均年齢は66歳で, 約70%が60歳以上の高齢者で, 一般細菌による複雑性尿路感染症における年齢分布とほぼ同じ傾向であった.真菌学的および細菌学的検討においては68例(44.7%)が真菌と細菌との混合感染例であった.真菌の分離頻度をみると, C. albicansは48株にすぎず, C. albicans以外の真菌が多数分離され, 82例に定常性がみられたのみで, 約40%の症例では尿中真菌は自然に消失していた.おもな4菌種に対する3薬剤(5-FC, MCZ, AMPH)のMICについては, T. beigeliiに対する5-FCのMICがやや高い値を示した以外, 全体にどの薬剤についても低い値を示し, 尿路から分離される真菌はほぼ良好な感受性を持つものと考えられる.5-FCを用いた尿路真菌症に対する治療経験でも, 有効率77.8%と良好な成績であったが, 5-FC投与中にMICが高値を示し, 二次耐性化したと考えられた症例を経験している

Clinical features of urinary fungal infections were analyzed in 152 patients in whom fungi were cultured from urine and mycologically identified between February, 1989 and June, 1990. The average age was 66 years old, and approximately 70% of the patients were 60 years old or older. Systemic and urinary tract underlying diseases were observed in 145 patients (95.4%) and 70 patients (46.1%) had urinary indwelling catheters. Previous use of antimicrobial agents before isolation of urinary fungi was recorded in 103 patients (67.8%), the 2nd and 3rd generation cephems and new quinolones being most frequent. A mixture of fungi and bacteria was observed in 68 patients (44.7%). Gram-positive cocci were isolated from 50% of them. Of 173 strains of fungi, C. glabrata was the most frequent (31.2%), followed by C. albicans (27.8%), C. tropicalis (17.3%) and T. beigelii (15.0%). All strains of C. glabrata, C. albicans, C. tropicalis and T. beigelii were highly sensitive to flucytosine (5-FC), miconazole (MCZ) and amphotericin B (AMPH), except for 3 strains which were resistant to 5-FC. The consecutiveness was confirmed by repeated culture in 59.4% of the patients. Fungi in the urine, however, spontaneously disappeared in the other patients.