感染をともなう尿路結石の細菌学的研究

Abstract

感染をともなう尿路結石120例について細菌学的検討および抗生物質の結石内移行について検索した.120例のうち104/ml以上の菌検出は65.8%であり, 同定菌株は101株で, proteus mirabilis 20, 7%, E. coli 18.8%の順に多かった.92結石につき赤外線分光分析を行ない, リン酸マグネシウムアンモニウム(MAP)およびその混合結石28.3%, リン酸カルシュウム(Cap)およびその混合結石52.2%, シュウ酸カルシュウム(CaOx)およびその混合結合15.2%であった.90結石の表層から53.3%に菌が検出され, 分離58株のうちproteus mirabilis 37.9%, E. coli 13.8%, pseudomonas aeruginosa 12.1%であり, 結石内層では75.8%に検出された菌株のうちproteus mirabilis 52.0%, Pseudomonas aeruginosa 16.0%であった.また結石内分離株と結石成分の関係, Cefmetazoleの結石内浸透についての検索を行った

There are difficult problems in the management of urinary calculi associated with infections. Stones associated with infections are not only infection stones such as struvite stones, but also other kinds of stones such as calcium oxalate. Therefore, from practical view points, bacteriological studies should be carried out on urinary calculi associated with infections as a whole. We investigated 120 cases of urinary calculi associated with infections with special reference to bacteria on the stone surface, within the stone, compositions of the stone and permeation of an antibiotic into the stone. Proteus was isolated most frequently from the urine, followed by E. coli and Pseudomonas. These bacteria were isolated from the stone surface, although the incidence of Proteus mirabilis was higher than that in the urine. Bacteria were isolated in 25 of the 33 specimens of the inside parts and in 12 of the 12 stones of MAP and MAP plus other components. Proteus mirabilis was found in 7 of the 12 stones. Bacteria were isolated from the inside of 9 of the 16 stones of CaP and CaP plus other components and Proteus mirabilis was found in 6 of these 9 cases. Pseudomonas was isolated in 2 out of the 7 stones of CaP plus CaOX and its growth was seen in 5 specimens. The incorporation of an antibiotic, Cefmetazole, into the stone differed greatly with each stone. There were some cases in which the concentration of Cefmetazole in the inside was less than 5% of that in the outside. Stones may function as a sanctuary for organisms and may protect these organisms.