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目的提高临床医师对氟康唑耐药念珠菌尿路感染的认识,为如何选择药物提供借鉴经验。方法回顾性分析我科近期一例有基础肾功能异常并氟康唑耐药热带念珠菌尿路感染艾滋病患者的救治过程,结合文献对念珠菌尿路感染的治疗进行分析。结果文献复习表明目前不推荐对无易感因素的无症状性念珠菌尿进行治疗。对于存在易感因素的患者,应首先控制易感因素。当患者存在播散性念珠菌风险时,或是存在明确的泌尿系统侵袭性感染时,需要抗念珠菌治疗。选择药物时需要结合药物的代谢动力学特征以及药敏实验结果,首选药物为氟康唑,氟康唑耐药菌株感染替代治疗方案主要为两性霉素B和氟胞嘧啶。本例有基线肾功能异常的患者能较好耐受低剂量两性霉素B联合足量氟胞嘧啶治疗方案,且疗效肯定。结论对于念珠菌尿应首先评估是否需要治疗。氟康唑是首选治疗药物,两性霉素B以及氟胞嘧啶是重要的备用治疗药物。本文特殊病例的救治过程,为有基线肾功能异常并氟康唑耐药念珠菌尿路感染的处理提供借鉴经验。
Objective To improve clinicians’ understanding of urinary tract infection with fluconazole-resistant Candida and provide experiences on how to choose drugs. Methods A retrospective analysis of our department a case of basic renal dysfunction and flu-resistant Candida tropicalis infection in patients with urinary tract infection in AIDS treatment, combined with the literature on the treatment of Candida urinary tract infection were analyzed. Results Literature review indicated that it is not currently recommended to treat asymptomatic Candida albicans without susceptibility. For patients with predisposing factors, the predisposing factors should be controlled first. Candida-resistant treatment is required when the patient has a risk of disseminated candidiasis or if there is a clear invasion of the urinary system. The choice of drugs need to combine the pharmacokinetic characteristics and drug susceptibility test results, the preferred drug for fluconazole, fluconazole-resistant strains of infection alternative treatment programs amphotericin B and flucytosine. In this case, patients with baseline renal dysfunction were better tolerated with low-dose amphotericin B in combination with adequate flucytosine regimens and the efficacy was confirmed. Conclusions Candida urine should be evaluated first whether treatment is needed or not. Fluconazole is the treatment of choice, and amphotericin B and flucytosine are important alternative therapies. This special case of the treatment process for the treatment of urinary tract infection with baseline renal dysfunction and fluconazole-resistant Candida bacteria provide experience.