22例儿童铜绿假单胞菌社区获得性尿路感染临床分析  

Clinical analysis of 22 cases community-acquired Pseudomonas aeruginosa urinary tract infection

作　　者：伏小红[1] 周雯[1] 张雪梅[2] 尹一兵[1] 景春梅[1] 刘岚[1] 赵洁[1] 

机构地区：[1]重庆医科大学附属儿童医院临检中心,400014 [2]重庆医科大学检验系

出　　处：《中华儿科杂志》2013年第4期298-301,共4页Chinese Journal of Pediatrics

摘　　要：目的研究儿童铜绿假单胞菌（PA）引起的社区获得性尿路感染（CAUls）的特征，分析其危险因素和对抗生素的敏感情况，为PA-CAUls的诊断和治疗提供参考依据。方法收集22例PA．CAUTIs患儿临床资料、实验数据和影像学特点，并与同一时期随机选择54例大肠埃希菌（Escherichiacoli，E．coli）引起的CAUls进行对比。结果22例PA-CAUTIs中白蛋白水平均值为（32．25±13．81）mg／ml、19例有住院史、6例有尿路手术史、7例长期使用糖皮质激素或免疫抑制剂、20例有基础疾病。与E．coli．CAUTIs进行比较，PA-CAUTIs患者的白蛋白水平更低（P=0．017），有住院史（P=0．03）、尿路手术史（P=0．03）、长期使用糖皮质激素或免疫抑制剂（P=0．044）史的比例更高。对单因素分析有统计学意义的变量（有住院史、长期使用糖皮质激素或免疫抑制剂、白蛋白值、有基础疾病、尿路手术史）进行多因素Logistic回归分析发现，有基础疾病（OR值8．500，95％C／1．513～47．761，P=0．037）和尿路手术史（OR值6．196，95％C／1．120-34．273，P=0．037）是PA-CAUTIs的独立危险因素。PA菌株对哌拉西林、氨曲南、庆大霉素的耐药率都为36．36％，对头孢吡肟、头孢他定的耐药率为31．82％，对碳青霉烯类抗生素的耐药率（4．55％）相对较低，只对多黏菌素为全部敏感。结论有基础疾病和尿路手术史是PA-CAUTIs发生的独立危险因素，碳青霉烯类抗生素和多黏菌素可考虑为其治疗的首选药物。Objective To study the characteristics of community-acquired urinary tract infections （CAUTIs） in children, analyze the risk factors and the susceptibility of antibiotics, thus to provide references to the diagnosis and medication of Pseudomonas aernginosa （PA） -CAUTIs. Mothod Totally 22 cases of PA-CAUTIs were selected in one hospital from Jan, 2006 to Jan, 2012, their clinical information, laboratory resuhs and radiological images were collected, and were compared with the CAUTIs cased by E. coli of those randomly selected over the same period. Result In those 22 cases with PA-CAUTIs, the mean value of protein level was （ 32. 25 ± 13.81 ） mg/ml, 19 of them were hospitalized, 6 had urinary operation history, 7 of them had long-term usage of glucocorticoids or immunosuppressive agents, and 20 had underlying diseases. A total of 22 children with 26 PA-CAUTIs episodes were compared to E. coli-CAUTIs. Compared with E. coli-CAUTIs patients, children with PA-CAUTIs more often presented with a lower albumin （ P = 0. 017 ）, a history of urinary operation （ P = 0.03 ）, more cases had a history of urinary operation （ P = 0.03 ）, a long-term usage of glucocorticoids or immunosuppressive medication （ P = 0. 044）. Through multivariate logistic regression of variables that were significant in univariate analysis （with hospitalizations, long-term usage of glucocorticoids or immunosuppressive, albumin, underlying disease and urinary operation histories）, and it turned out that underlying diseases （odds ratio 8. 500, 95% CI 1. 513 - 47.761, P = 0. 037） and with urinary operation histories （ odds ratio 6. 196, 95% CI 1. 120 - 34. 273, P = 0. 037 ） were proved as the independent risk factors for PA-CAUTIs. Those PA bacterial strains had a36. 36% resistance rate to piperacillin, aztreonam and gentamicin, a 31.82% resistance rate to cefepime and ceftazidime, while the resistance rate （4. 55% ） to carbapenem antibiotics was relatively low, only to bacillosporin all the strains were sensiti

关 键 词：假单胞菌 铜绿 社区获得性感染 泌尿道感染 肠出血性大肠杆菌 

分 类 号：R446.5[医药卫生—诊断学]