目的

分析上尿路结石合并尿真菌培养阳性患者的临床特点，总结诊疗中的经验及教训，为临床诊治提供参考。

方法

回顾性收集2016 年9 月至2021 年9 月广州医科大学附属第二医院泌尿外科94 例上尿路结石合并尿真菌培养阳性患者的临床资料，对患者的临床特点及围手术期抗菌药物的应用及术后感染情况进行分析。

结果

94 例患者中位结石长径19（10，25）mm，多发性结石73 例（77.7%）。就诊时留置导管（尿管、DJ 管、肾造瘘管）46 例（48.9%），3 个月内结石手术史40 例（42.6%），3 个月内使用抗生素36 例（38.8%），合并2 型糖尿病19 例（20.2%）。最常见的真菌类型为热带念珠菌（33/94，35.1%），其次为白色念珠菌（30/94，31.9%）。其中单一泌尿系真菌感染80 例（85.1%），泌尿系混合感染14 例（14.9%）。所有真菌菌株均对两性霉素B 和伏立康唑的敏感性较强，敏感率均高于氟康唑、氟胞嘧啶和伊曲康唑（P＜0.05）。所有患者中使用抗真菌药物47 例（50.0%），中位使用6（3，9）d。手术治疗84 例（89.4%），术后出现发热（＞38℃）33 例（39.3%），全身炎症反应综合征26 例（31.0%），脓毒血症4 例（4.8%）。单一泌尿系真菌感染患者中，术前未使用抗真菌药的患者术后发热率为43.5%（20/46），明显高于术前使用抗真菌药的患者11.8%（2/17）（P＜0.05）。在术前使用抗细菌药、未使用抗真菌药的情况下，混合感染患者术后发热率（10/12，83.3%）明显高于单一真菌感染患者（20/46，43.5%） （P＜0.05），共49 例术后患者出院后3 月复查尿培养，其中术后发热患者出院后复查尿培养真菌阳性率为60.7%（17/28），明显高于术后无发热患者尿培养真菌阳性率23.8%（5/21） （P＜0.05）。

结论

上尿路结石合并真菌尿的患者通常病史复杂且术后出现感染并发症风险高。最常见的真菌类型是热带念珠菌及白色念珠菌。术前使用抗真菌药物可降低患者术后发热率，临床上对于此类患者的围手术期管理需要进一步规范化。

Objective

To Analyze the clinical characteristics of patients with upper urinary tract stones combined with positive urine fungal cultures， summarize experiences and lessons learned in diagnosis and treatment， and offer guidance for clinical practice.

Methods

Clinical data from 94 patients with upper urinary tract stones combined with positive urine fungal cultures between September 2016 and September 2021 in the secondAffiliated Hospital of Guangzhou Medical University were collected retrospectively.We analyzed the clinical characteristics of these patients， the use of antimicrobial agents during the perioperative period， and the incidence of postoperative infections.

Results

The stone length was 19（10， 25） mm in the 94 patients， with 73 cases （77.7%） having multiple stones.At the time of presentation， 46 cases （48.9%） had indwelling catheters （ureteral stent， DJ stent， nephrostomy tube）， 40 cases （42.6%） had a history of stone surgery within 3 months， and 36 cases （38.8%） had received antibiotics within the same period.Additionally，19 cases （20.2%） had type 2 diabetes.The most common fungal species were Candida tropicalis （33/94，35.1%） and Candida albicans （30/94， 31.9%）.Among the patients， 80（85.1%） had isolated urinary fungal infections， while 14（14.9%） had concomitant urinary bacterial infections.All fungi were highly sensitive to amphotericin B and voriconazole with the sensitility rates being higher than those of fluconazole，flucytosine， and itraconazole （P＜0.05）.Antifungal drugs were used in 47 cases （50.0%） with a duration of 6（3， 9） days.Surgical intervention was performed in 84 cases （89.4%）， with postoperative fever （＞38°C）observed in 33 cases （39.3%）， systemic inflammatory response syndrome in 26 cases （31.0%）， and sepsis in 4 cases （4.8%）.Among patients with isolated urinary fungal infections， those who did not receive antifungal treatment preoperatively had a significantly higher postoperative fever rate （43.5%， 20/46） compared to those who did （11.8%， 2/17） （P＜0.05）.In patients with fungal and bacterial coinfections， the postoperative fever rate was significantly higher in those without preoperative antifungal treatment （83.3%， 10/12） compared to those without bacterial coinfections （43.5%， 20/46） （P＜0.05）.Of the 49 patients who underwent urine culture retesting 3 months post-discharge， the fungal positive rate was significantly higher in patients with postoperative fever （60.7%， 17/28） compared to those without （23.8%， 5/21） （P＜0.05）.

Conclusion

Patients with upper urinary tract calculi combined with positive urine fungal cultures often present with complex medical histories and a heightened risk of postoperative infections and complications.The predominant fungal species identified were Candida tropicalis and Candida albicans.Preoperative antifungal therapy was associated with a reduced postoperative fever rate.Therefore， there is a need for further standardization of perioperative management for this patient population to optimize clinical outcomes.