小儿尿路感染单中心临床和细菌耐药分析  

Clinical manifestation and drug resistance analysis in children with urinary tract infection:a single center experience

作　　者：王灵芝[1,2] 康郁林[1,2] 张泓[1,2] 黄文彦[1,2] 朱光华[1,2] 

机构地区：[1]上海交通大学附属儿童医院 [2]上海市儿童医院肾脏风湿科,上海200040

出　　处：《中国实用儿科杂志》2015年第4期274-277,共4页Chinese Journal of Practical Pediatrics

基　　金：上海市卫生和计划生育委员会青年科研项目基金资助[项目编号:2010Y143]

摘　　要：目的探讨尿路感染(UTI)患儿临床特点、病原菌分布及耐药情况,以期合理指导临床治疗。方法以2010年1月至2013年12月上海交通大学附属儿童医院明确诊断UTI住院患儿264例为研究对象,对其临床资料、中段尿培养、药敏结果辅助检查及治疗情况进行回顾性分析。结果 UTI患儿中位年龄10个月,且以<1岁的婴儿多见,为146例(55.30%)。264例中男多于女(1.095∶1),其中单纯性UTI 83例,余181例合并各种复杂因素。合并复杂因素中感染因素居首位(28.18%),其次为肾积水(17.13%)、膀胱输尿管反流(VUR,14.92%)、其他泌尿系统畸形(9.39%)等。尿培养共培养出病原菌138株,以大肠埃希菌(63.04%)和肺炎克雷伯杆菌(10.14%)等革兰阴性细菌为主,革兰阳性菌中以粪肠球菌(4.35%)为主。产超广谱β-内酰胺酶(ESBLs)率:大肠埃希菌产酶率为68.97%(60/87),肺炎克雷伯杆菌高达78.57%(11/14)。药敏结果:细菌对头孢菌素类耐药率较高,如大肠埃希菌和肺炎克雷伯杆菌对头孢呋辛、头孢噻肟和头孢他啶的耐药率达60%以上;而对碳氢酶烯类敏感率高,达85%以上,但发现了对亚胺培南、美罗培南的耐药菌株。泌尿系超声检查264例,异常44例(16.67%)。56例行MCU检查,发现27例存在VUR(男20例、女7例),年龄3个月至8岁。264例经治疗后UTI症状均好转,其中92例肾积水、VUR等泌尿系统畸形转至泌尿外科门诊随访。结论对小年龄UTI患儿应加强泌尿系超声和同位素等检查排除有无肾积水、VUR等泌尿系统畸形,男性患儿还应排除隐匿阴茎。鉴于本中心UTI患儿高耐药率和高产酶率现象,需进一步研究其耐药机制。Objective To understand the clinical characteristics of children with urinary tract infection（UTI）, and in- vestigate the distribution and drug resistance of pathogenic bacteria, in order to guide clinical treatment. Methods To- tally 264 UTI cases of hospitalized patients were enrolled in Shanghai Children＇ s Hospital from 2010 to 2013. The clini- cal data, clean midstream urine culture results and drug susceptibility results were analyzed. Results In children with UTI, median of the age was 10 months, and mostly were infants. The number of boys was more than girls. Among the complex factors involved, infection was the most common one. In addition, urinary abnormalities such as hydronephro- sis, VUR and buried penis in boys were the high risk factors as well. Urinary culture results： Gram-negative bacteria such as E.coli and Klebsiella pneumoniae accounted for the majority of pathogens. Enterobacteriaceae was the most com- mon type of gram-positive bacteria. The isolated ratio of ESBLs producing E.coli was 68.97%, while Klebsiella pneu- moniae was up to 78.57%. Drug susceptibility ： cephalosporins had a relatively high drug resistance rate, resistance rate of Escherichia coli and Klebsiella pneumoniae was more than 60% to cefuroxime, cefotaxime and ceftazidime; whereas carbapenems had a high sensitivity rate of more than 85%, but the strains which were resistant to imipenem and merope-nem were also shown. Conclusion It is necessary to strengthen the urinary tract ultrasound and isotopic exam- inations. Further study is needed to know the mechanism of drug resistance.

关 键 词：尿路感染 膀胱输尿管反流 尿培养 药敏试验 

分 类 号：R72[医药卫生—儿科]