Abstract:

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.

Key words: Upper urinary calculi, Positive urine fungal culturess, Clinical characteristics, Antibiotic susceptibility analysis