两性霉素B膀胱冲洗治疗真菌尿的荟萃分析

白向荣; 程红勤; 张雁; 金颖

doi:10.3969/j.issn.1006-0111.2018.04.021

两性霉素B膀胱冲洗治疗真菌尿的荟萃分析

doi: 10.3969/j.issn.1006-0111.2018.04.021

首都医科大学宣武医院药剂科, 北京 100053

A Meta-analysis on the efficacy and safety of amphotericin B bladder irrigation in the treatment of urinary fungal infection

Department of Pharmacy, Xuanwu Hospital, Capital Medical University, Beijing 10053, China

摘要: 目的系统评价两性霉素B膀胱冲洗真菌尿路感染的有效性和安全性。方法检索Pubmed、Embase、WEB OF SCIENCE、Cochrane图书馆、万方数据库、维普数据库、中国生物医学文献服务系统数据库。纳入两性霉素B膀胱冲洗治疗真菌尿路感染作用的横断面或对照研究。结果共纳入12个随机对照研究，853例患者，荟萃（Meta）分析结果表明，两性霉素B膀胱冲洗后24 h和 > 5 d，真菌清除率分别为0.81[0.75，0.87]和0.71[0.63， 0.79]，具有统计学意义。冲洗后24 h真菌清除率结果：持续冲洗的真菌清除率为0.83[0.75，0.91]，间断冲洗的真菌清除率为0.78[0.68，0.88]。冲洗后 > 5 d真菌清除率结果：持续冲洗的真菌清除率为0.74[0.65，0.84]，而间断冲洗的真菌清除率为0.60[0.44，0.76]。差异均具有统计学意义。两性霉素B膀胱冲洗与氟康唑相比，在冲洗后24 h真菌清除率和冲洗后 > 5 d真菌清除率分别为1.27[1.07，1.50]和0.92[0.78，1.10]。安全性方面有血尿的报道。结论两性霉素B膀胱冲洗具有真菌清除作用，持续冲洗方式优于间断冲洗。具有与全身使用氟康唑相同的真菌清除效果，可以作为尿路感染的治疗方案。但由于受纳入文献的数质量的限制，仍然需要大规模、设计严谨的随机、对照、双盲的临床试验去进一步验证其效果。
- 膀胱冲洗 /
- 两性霉素B /
- 真菌尿 /
- 荟萃分析 /
- 系统评价
Abstract: Objective Systematic evaluation of effectiveness and safety of amphotericin B bladder irrigation in urinary tract fungal infection. Methods Cross-sectional or controlled studies of amphotericin B bladder irrigation in the treatment of urinary tract fungal infection were collected by the search of Pubmed, Embase, WEB OF SCIENCE, Cochrane Library, Wanfang Database, ViP Database and SinoMed. Results 12 studies with 853 patients were included. Amphotericin B bladder irrigation had fungal clearance rate RR=0.81[0.75, 0.87] after 24 hours and 0.71[0.63, 0.79] after > 5 days. Clearance of candiduria in 24 hours with amphotericin B continuous irrigation was 0.83[0.75,0.91], while the intermittent bladder irrigation was 0.78[0.68,0.88]. Clearance of candiduria >5 days for those two groups was 0.74[0.65,0.84] and 0.60[0.44,0.76]. In the comparative studies with amphotericin B bladder irrigation vs fluconazole, clearance of candiduria in 24 hours and> 5 days was 1.27[1.07,1.50] and 0.92[0.78,1.10]. There was a report of hematuria with amphotericin B bladder irrigation. Conclusion Amphotericin B bladder irrigation showed similar efficacy in candiduria clearance as the systemic treatment with fluconazole. The continuous bladder irrigation with amphotericin B is more effective than intermittent irrigation. Due to the limited literatures available, the large scale double blinded clinical trials are needed to verify the efficacy.
- bladder irrigation /
- amphotericin B /
- candiduria /
- Meta-analysis /
- systematic review

[1]	WISE GJ,WAINSTEIN S,GOLDBERG P,et al. Candidal cystitis. Management by continuous bladder irrigation with amphotericin B[J]. JAMA,1973,224(12):1636-1637.
[2]	WISE GJ,KOZINN PJ,GOLDBERG P. Amphotericin B as a urologic irrigant in the management of noninvasive candiduria[J]. J Urol,1982,128(1):82-84.
[3]	HSU CC,UKLEJA B. Clearance of Candida colonizing the urinary bladder by a two-day amphotericin B irrigation[J]. Infection,1990,18(5):280-282.
[4]	JACOBS LG,SKIDMORE EA,CARDOSO LA,et al. Bladder irrigation with amphotericin B for treatment of fungal urinary tract infections[J]. Clin Infect Dis,1994,18(3):313-318.
[5]	TRINH T,SIMONIAN J,VIGIL S,et al. Continuous versus intermittent bladder irrigation of amphotericin B for the treatment of candiduria[J]. J Urol,1995,154(6):2032-2034.
[6]	LEU HS,HUANG CT. Clearance of funguria with short-course antifungal regimens:a prospective,randomized,controlled study[J]. Clin Infect Dis,1995,20(5):1152-1157.
[7]	FAN-HAVARD P,O'DONOVAN C,SMITH SM,et al. Oral fluconazole versus amphotericin B bladder irrigation for treatment of candidal funguria[J]. Clin Infect Dis,1995,21(4):960-965.
[8]	FONG IW. The value of a single amphotericin B bladder washout in candiduria[J]. J Antimicrob Chemother,1995,36(6):1067-1071.
[9]	JACOBS LG,SKIDMORE EA,FREEMAN K,et al. Oral fluconazole compared with bladder irrigation with amphotericin B for treatment of fungal urinary tract infections in elderly patients[J]. Clin Infect Dis,1996,22(1):30-35.
[10]	NESBIT SA,KATZ LE,MCCLAIN BW,et al. Comparison of two concentrations of amphotericin B bladder irrigation in the treatment of funguria in patients with indwelling urinary catheters[J]. Am J Health Syst Pharm,1999,56(9):872-875.
[11]	朱卫华,马峰. 两性霉素B膀胱冲洗治疗尿路真菌感染临床分析[J]. 中外医疗,2015,34(18):127-128,131.
[12]	SULLIVAN KA,CAYLOR MM,LIN FC,et al. Comparison of amphotericin B bladder irrigations versus fluconazole for the treatment of candiduria in intensive care unit patients[J]. J Pharm Pract,2017,30(3):347-352.
[13]	PAPPAS PG,KAUFFMAN CA,ANDES DR,et al. Clinical practice guideline for the management of candidiasis:2016 update by the Infectious Diseases Society of America[J]. Clin Infect Dis,2016,62(4):e1-50.
[14]	李延鸿,朱怀军. 膀胱冲洗对预防留置导尿管引起尿路感染作用的系统评价[J]. 实用药物与临床,2012,15(8):494-496.
[15]	SOBEL JD,KAUFFMAN CA,MCKINSEY D,et al. Candiduria:a randomized,double-blind study of treatment with fluconazole and placebo. The National Institute of Allergy and Infectious Diseases (NIAID) Mycoses Study Group[J]. Clin Infect Dis,2000,30(1):19-24.
[16]	TUON FF,AMATO VS,PENTEADO FILHO SR. Bladder irrigation with amphotericin B and fungal urinary tract infection systematic review with Meta-analysis[J]. Int J Infect Dis,2009,13(6):701-706.

[1]	孙丹倪, 黄勇, 张嘉宝, 王培. 代谢相关脂肪性肝病的无创诊断与药物治疗 . 药学实践与服务, 2024, 42(10): 411-418. doi: 10.12206/j.issn.2097-2024.202403049
[2]	王耀振, 徐灿, 吕顺莉, 田泾, 张东炜. 钾离子竞争性酸阻滞剂的药学特征研究进展 . 药学实践与服务, 2024, 42(7): 278-284. doi: 10.12206/j.issn.2097-2024.202306040
[3]	黄韵, 张正银, 金英, 郑怡菁, 李铁军, 孙莉莉. 耐碳青霉烯类肺炎克雷伯菌及大肠埃希菌临床分离株耐药性及耐药基因分析 . 药学实践与服务, 2024, 42(10): 439-444. doi: 10.12206/j.issn.2097-2024.202309059
[4]	史生辉, 石飞, 雷琼, 王亚峰, 吴雪花. 青藏高原肺结核合并念珠菌感染患者的病原菌分布特点及耐药率分析 . 药学实践与服务, 2024, 42(6): 260-262, 272. doi: 10.12206/j.issn.2097-2024.202304014
[5]	刘依秦, 王超群, 邱娇娜. 胆宁片预处理在糖尿病患者结肠镜检查前的应用效果分析 . 药学实践与服务, 2024, 42(9): 407-410. doi: 10.12206/j.issn.2097-2024.202407037
[6]	瞿文君, 白若楠, 崔力, 周琰. 基于联合库存的公立医院多院区药品采购模式分析 . 药学实践与服务, 2024, 42(7): 315-318. doi: 10.12206/j.issn.2097-2024.202401002
[7]	宋红卫, 王燕, 方铭, 马云鹏, 钟超, 徐一新, 徐峰, 周婷. 2021−2023年我院药品不良反应的特点分析 . 药学实践与服务, 2024, 42(): 1-6. doi: 10.12206/j.issn.2097-2024.202404041
[8]	崔晓林, 付晓菲, 杜艳红, 刘娟, 朱茜, 刘子祺. 临床药师参与吉瑞替尼致QTc间期延长的病例分析 . 药学实践与服务, 2024, 42(6): 263-266. doi: 10.12206/j.issn.2097-2024.202309050
[9]	尹小娟, 台力丽, 肖俊峰, 季波. 铜绿假单胞菌合并按蚊伊丽莎白菌肺部感染的病例分析 . 药学实践与服务, 2024, 42(5): 223-226. doi: 10.12206/j.issn.2097-2024.202310042
[10]	宋雨桐, 夏德润, 顾珩, 唐少文, 易洪刚, 沃红梅. 帕博利珠单抗与铂类化疗方案在晚期非小细胞肺癌一线治疗中的药物经济学评价 . 药学实践与服务, 2024, 42(8): 334-340. doi: 10.12206/j.issn.2097-2024.202303023
[11]	张岩, 李炎君, 刘家荟, 邓娇, 原苑, 张敬一. 药物性肝损伤不良反应分析 . 药学实践与服务, 2024, 42(): 1-5. doi: 10.12206/j.issn.2097-2024.202404034
[12]	王鹏, 陈顺, 赵逸, 高守红, 王志鹏. 卡培他滨致小鼠手足综合征模型的建立及评价 . 药学实践与服务, 2024, 42(9): 385-388, 398. doi: 10.12206/j.issn.2097-2024.202308045
[13]	景凯, 杨慈荣, 张圳, 臧艺蓓, 刘霞. 黄芪甲苷衍生物治疗慢性心力衰竭小鼠的药效评价及作用机制研究 . 药学实践与服务, 2024, 42(5): 190-197. doi: 10.12206/j.issn.2097-2024.202310004
[14]	练鲁英, 刘盈, 殷佳, 诸国樑, 徐飞. 上海某三级公立医院药品管理内部控制评价实践研究 . 药学实践与服务, 2024, 42(): 1-7. doi: 10.12206/j.issn.2097-2024.202402003
[15]	刘丽艳, 余小翠, 孙传铎. 纳武利尤单抗治疗非小细胞肺癌有效性及安全性的Meta分析 . 药学实践与服务, 2024, 42(10): 451-456. doi: 10.12206/j.issn.2097-2024.202310044
[16]	张艺昕, 关欣怡, 王博宁, 闻俊, 洪战英. 二氢吡啶类钙离子拮抗药物手性分析及其立体选择性药动学研究进展 . 药学实践与服务, 2024, 42(8): 319-324. doi: 10.12206/j.issn.2097-2024.202308062
[17]	戴菲菲, 傅翔, 陈琼年, 俞苏纯. 上海某二级医院革兰阴性菌流行特征的回顾性分析 . 药学实践与服务, 2024, 42(): 1-5. doi: 10.12206/j.issn.2097-2024.202305005
[18]	张晶晶, 索丽娜, 郑兆红. 89例细菌性肝脓肿的临床特征及抗感染治疗分析 . 药学实践与服务, 2024, 42(6): 267-272. doi: 10.12206/j.issn.2097-2024.202302039
[19]	陈怡君, 王卓, 何苗, 张宇, 田泾. 泌尿系统碎石术抗菌药物预防使用合理管控实践 . 药学实践与服务, 2024, 42(): 1-5. doi: 10.12206/j.issn.2097-2024.202402034
[20]	杨嘉宁, 赵一颖, 肖伟. 七味脂肝方对非酒精性脂肪性肝炎动物模型的药效学评价 . 药学实践与服务, 2024, 42(9): 389-398. doi: 10.12206/j.issn.2097-2024.202404096

点击查看大图

计量

文章访问数: 3527
HTML全文浏览量: 669
PDF下载量: 493
被引次数: 0

姓名
邮箱
手机号码
标题
留言内容
验证码

留言板

两性霉素B膀胱冲洗治疗真菌尿的荟萃分析

doi: 10.3969/j.issn.1006-0111.2018.04.021

A Meta-analysis on the efficacy and safety of amphotericin B bladder irrigation in the treatment of urinary fungal infection

计量

两性霉素B膀胱冲洗治疗真菌尿的荟萃分析

doi: 10.3969/j.issn.1006-0111.2018.04.021

首都医科大学宣武医院药剂科, 北京 100053

English Abstract

A Meta-analysis on the efficacy and safety of amphotericin B bladder irrigation in the treatment of urinary fungal infection

Department of Pharmacy, Xuanwu Hospital, Capital Medical University, Beijing 10053, China

全文HTML

目录

留言板

两性霉素B膀胱冲洗治疗真菌尿的荟萃分析

doi: 10.3969/j.issn.1006-0111.2018.04.021

A Meta-analysis on the efficacy and safety of amphotericin B bladder irrigation in the treatment of urinary fungal infection

计量

出版历程

两性霉素B膀胱冲洗治疗真菌尿的荟萃分析

doi: 10.3969/j.issn.1006-0111.2018.04.021

首都医科大学宣武医院药剂科, 北京 100053

English Abstract

A Meta-analysis on the efficacy and safety of amphotericin B bladder irrigation in the treatment of urinary fungal infection

Department of Pharmacy, Xuanwu Hospital, Capital Medical University, Beijing 10053, China

全文HTML

目录