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.

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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

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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

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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