尿管皮膚瘻造設術後症例における尿培養分離菌の検討

Abstract

Twenty-four patients with cutaneous ureterostomy at least 6 months after surgery were included in this study. Single-J ureteral catheters were indwelt in 7 patients. Pouch urine was cultured and analyzed from asymptomatic patients and from those with pyelonephritis. Forty-eight bacterial strains were isolated from asymptomatic patients. Thirty-five of these strains consisting of 18 species were isolated from the patients without ureteral catheters. Enterococcus (E.) faecalis (20.0%), Klebsiella pneumoniae (11.4%) and Proteus (P.) mirabilis (11. 4%) were isolated at high frequency. One methicilline-resistant coagulase-negative Staphylococcus (MRCNS) strain was isolated. Thirteen bacterial strains consisting of 8 species were isolated from the patients with ureteral catheters. E. faecalis (23.1%), Eschericia (E.) coli (23.1%) and Pseudomonas (P.) aeruginosa (15.4%) were isolated at high frequency. One E. coli strain harboring extended-spectrum beta lactamase (ESBL) and one MRCNS strain were isolated. Pyelonephritis occurred in 5 patients 14 times during follow-up for at least 6 months after surgery. The patients with ureteral catheters suffered from pyelonephritis (4/7, 57.1%) more frequently as compared to the patients without catheters (1/17, 5.9%) (p＝ 0.014). P. aeruginosa (26.9%), E. faecium (15.4%), and P. mirabilis (11.5%) were isolated inhigh frequency. One E. coli strain harboring ESBL and one P. mirabilis strain harboring ESBL were isolated. In conclusion, insertion of ureteral catheters in a cutaneous ureterostomy is a strong risk factor for pyelonephritis and development of antibiotic-resistant bacteria. Therefore, urine culture is important in these patients who are under surveillance.