念珠菌菌尿症：臨床評估與處置

Candiduria: Clinical Evaluation and Treatment

念珠菌菌尿症（candiuria）是一常困惑著諸多醫師的臨床發現，它不同於細菌性菌尿症（bactereuria），尚缺乏著一確定性的診斷標準。雖然泌尿道感染症仍是以細菌類的病原菌為主，但現今由於醫療環境的改變導致尿液培養分離出念珠菌屬的比率已逐漸增加，因此更需去加以探討臨床處置的問題。念珠菌菌尿症臨床上多屬於無症狀性的臨床發現，統計上院內感染型的念珠菌菌尿症比率大於社區型，在一些特殊族群像是年老女性、解剖構造異常、糖尿病、加護病房重症病人、和尤其是有留置泌尿道導管的病患更是常見。從尿液分離出的念珠菌菌種統計則是以白色念珠菌（Candida albicans）占最大宗。當發現念珠菌菌尿症時，需仔細去評估臨床上是否有造成相關的泌尿道感染診斷，之後才是考慮加以治療。抗黴菌藥物的選擇則以fluconazole為首選，另外若是發現有泌尿道阻塞或是組織膿瘍形成時，也需考慮進一步的外科引流處置。不論何時，在臨床情況允許下移除留置的泌尿道導管永遠是該加以考慮的。在評估泌尿道感染症上，由於念珠菌菌尿症尚缺乏一套確切的判定標準，因此尚仰賴著臨床醫師多做診斷評估。

Management of candiduria is controversial in clinical practice. No standard guidelines are available for the diagnosis and the optimal treatment of candiduria. Notably, candiduria may be the only indicator of more serious invasive candidiasis, particularly in immunocompromised patients. Long-term urinary catheterization is considered the most significant risk factor for candiduria, followed by antibiotic use and diabetes. Management strategies are based on the evaluation of candiduria in a clinical setting to determine its relevance, followed by decision-making regarding antifungal therapy. Fluconazole is the mainstay of treatment considering its efficacy and lowest complication rate compared with other agents. Amphotericin B and flucytosine are useful alternatives. Unavailability of reliable diagnostic tests leads to difficulty in distinguishing between colonization/contamination and true infection in patients with candiduria. Therefore, meticulous clinical assessment is warranted for accurate diagnosis and management.