Fungal İdrar Yolu Enfeksiyonları Tanı ve Tedavisi
Özet
Fungal üriner sistem enfeksiyonlarında en sık izole edilen patojenler Candida türleri olup, sağlıklı bireylerde nadir görülen candidüri; hastanede yatanlarda, böbrek nakilli alıcılarda ve yenidoğanlarda belirgin şekilde artış göstermektedir. En sık C. albicans saptanmakla birlikte, idrar kültürlerinde izole edilen suşların %50'sinden fazlasını antifungal direnci yüksek C. glabrata, C. tropicalis, C. krusei ve C. parapsilosis gibi albicans-dışı Candida türleri oluşturmaktadır. Üriner kateterizasyon, geniş spektrumlu antibiyotik kullanımı, konjenital anomaliler, taşlar, diyabet ve immünsüpresif tedaviler candidüri gelişiminde başlıca risk faktörleridir. Enfeksiyon asendan yol veya hematojen yayılımla meydana gelir; vakaların büyük çoğunluğu asemptomatik seyretse de renal tutulum pyelonefrit, apse formasyonu ve üriner obstrüksiyona yol açan fungus topu ile komplike olabilir. Yenidoğanlarda akut böbrek hasarı ve fungus topu oluşumu daha sık gözlenirken, ultrasonografi akustik gölgesi bulunmayan hiperekojen kitleleri saptamada önemli bir tanı aracıdır. Enfeksiyon, kolonizasyon ve kontaminasyon ayrımında suprapubik aspirasyon en güvenilir yöntemdir. Sistemik tedavide ilk seçenek flukonazol iken, yenidoğan döneminde Amfoterisin-B tercih edilir; tıkanıklığa yol açan fungus toplarında nefrostomi, renal pelvis irrigasyonu veya cerrahi müdahale uygulanabilir. Gereksiz kateterlerin çekilmesi ve antibiyotik kullanımının sınırlandırılması temel koruyucu önlemlerdir.
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