無カテーテル尿管皮膚瘻における細菌感染の検出について

Abstract

Tubeless ureterocutaneostomyの腎盂細菌叢の存在とその検出方法につき考察した.1) Single lumen catheterを使用するストーマからの腎盂導尿法は皮膚細菌叢の混入による汚染も少なく, 有用な方法になりうると想像した.2)腎盂内細菌叢の出現率は19腎・尿管中9/19であったが, うち, 膿尿(毎視野5個以上の白血球が存在)の合併は2腎・尿管のみであった.3)水腎症の存在と腎盂細菌叢の出現間には有意な関係は認めなかった.4)腎盂細菌叢の経時的変遷では菌交代または消失はS. faecalisにもっとも多く, その他, S. aureus, S. epidermidis, P. aeruginosaであった.この問題の詳細は不明であった

The presence of bacteria at the renal pelvis and the methods of their detection were studied in 11 patients with catheter-free cutaneous ureterostomy (tubeless ureterocutaneostomy). These patients had had total radical cystectomy due to bladder carcinoma. Of these, 5 patients had single-sided stoma with 9 kidney-ureter units and 6 patients had bilateral stoma with 10 units, excluding 2 ureters because of indwelling catheters. The urine obtained both from the renal pelvis with a single lumen catheter and from the pouch were used in the bacterial culture test and urinalysis. The aseptic swab after touching the skin around the stoma was also cultured for bacteria. Of 19 kidney-ureter units, 9 (47%) were found to have bacteria in urine obtained from catheterization. However, only 2 units (11%) were observed to be accompanied with pyuria. In this method, the rate of bacterial appearance was higher in single-sided stomas than in bilateral ones. There was no statistical correlation between the presence of hydronephrosis and the rate of bacterial appearance. In conclusion, the method of single lumen catheterization might be of great use for analysis of urinary tract infections in patients with such conditions.