儿童尿路感染临床特点及病原菌分布和耐药性  

Clinical characteristics,pathogen distribution and antibiotic resistance of urinary tract infections in children

作　　者：李湘燕[1] 杨阳[1] 王玉芳[1] 

机构地区：[1]北京大学第一医院抗感染科临床药理研究所,北京100034

出　　处：《中国感染与化疗杂志》2016年第5期536-540,共5页Chinese Journal of Infection and Chemotherapy

摘　　要：目的分析儿童尿路感染的临床特点,主要病原菌分布、药敏结果及耐药菌产生的危险因素,为临床抗感染治疗提供依据。方法对北京大学第一医院2009-2013年住院的179例尿路感染患儿进行回顾性分析。Logistic回归分析大肠埃希菌产ESBL的危险因素。结果各年龄段患儿尿路感染的膀胱输尿管反流比例没有明显差异。3岁以上2个年龄组泌尿系结构异常、应用激素及免疫抑制剂比例显著高于3岁以下组。尿中分离的病原菌前3位分别是大肠埃希菌（34.6%）,屎肠球菌（25.7%）和铜绿假单胞菌（13.4%）。大肠埃希菌产ESBL率为77.4%,大肠埃希菌对头孢唑林、头孢呋辛、头孢噻肟耐药率均＆gt;70%,铜绿假单胞菌对各类抗菌药物耐药率均〈20%,肠球菌中未发现耐万古霉素菌株。Logistic回归分析显示近期应用抗菌药物是大肠埃希菌产ESBL的独立危险因素（P〈0.009,OR：20.02,95%CI：2.143-187.07）。结论泌尿系统畸形、膀胱输尿管反流和激素、免疫抑制剂的应用是儿童尿路感染的主要易患因素。先前抗菌药物的使用是儿科尿路感染耐药菌产生的重要危险因素。Objective To analyze the clinical features,pathogen distribution and antibiotic resistance profile of urinary tract infections in children.Methods A total of 179 cases of urinary tract infection in children from January 2009 to December 2013 were included in this retrospective analysis.The clinical and laboratory data were collected from electronic medical records.Logistic regression analysis was performed to identify the risk factors for the detection of ESBLs-producing Escherichia coli.Results The prevalence of vesicoureteral reflux did not show significant difference among different age groups.Urinary tract malformation,prior corticosteroid use and immunosuppressant therapy were found in significantly higher proportion in the older children（≥3 years） compared to the younger infants（〈3 years）.The top three bacterial species isolated from urine were E.coli（34.6%）,Enterococcus faecium（25.7%） and Pseudomonas aeruginosa（13.4%）.The prevalence of ESBLs-producing E.coli was 77.4%.More than 70% of the E.coli strains were resistant to cefazolin,cefuroxime and cefotaxime,while less than 10% were resistant to nitrofurantoin.Not more than 20% of the P.aeruginosa isolates were resistant to any one of the antibiotics tested.No vancomycin-resistant Enterococcusstrain was identified.Logistic regression analysis showed that recent antibiotic use was independent risk factor for ESBL production in E.coli（P〈0.009,OR： 20.02,95% CI：2.143-187.07）.Conclusions Urinary tract malformation,vesicoureteral reflux,prior corticosteroid use and immunosuppressant therapy are important predisposing factors for urinary tract infections in children.Extensive antibiotic therapy is a potential risk factor for emergence of antibiotic resistance in pediatric patients.

关 键 词：儿童 尿路感染 细菌耐药 

分 类 号：R446.5[医药卫生—诊断学] R726.9[医药卫生—临床医学]