丹阳地区375例小儿尿路感染病原菌分布及耐药性分析  

Pathogen distribution and drug resistance analysis of 375 case of children with urinary tract infection in Danyang district

作　　者：王丽琴[1] 方拥军[2] 金晓红 何启峰 

机构地区：[1]丹阳市儿童医院儿内科,江苏212300 [2]南京医科大学附属南京儿童医院血液科,江苏南京210008

出　　处：《现代医药卫生》2017年第20期3109-3112,共4页Journal of Modern Medicine & Health

摘　　要：目的探讨丹阳地区小儿尿路感染(UTI)病原菌分布、变迁及其耐药性,以指导临床安全用药。方法收集丹阳市儿童医院2011—2015年12月住院的UTI患儿420例,回顾性分析患儿的临床资料及观察尿培养病原菌分布及耐药性变迁。结果 420例患儿尿培养共检出细菌375株,以革兰阴性菌为主[92.3%(346/375)],大肠埃希菌居首位[70.0%(263/375)]。革兰阳性菌占7.7%(29/375),其中屎肠球菌占4.3%(16/375),粪肠球菌占1.1%(4/375),葡萄球菌属占2.4%(9/375)。对比分析2011—2012年及2013—2015年革兰阳性菌、革兰阴性菌总体分布情况及前5位致病菌分布情况,革兰阴性菌感染率高于革兰阳性菌;革兰阴性菌感染率有上升趋势,肺炎克雷伯菌有明显增加,差异有统计学意义(P<0.05)。在革兰阴性菌中,大肠埃希菌对阿莫西林耐药率最高,对亚胺培南、美罗培南、哌拉西林/他唑巴坦、阿米卡星、阿莫西林克拉维酸钾、头孢西丁均较不敏感;革兰阳性菌中屎肠球菌耐药性相对复杂,治疗可选用较敏感的万古霉素、呋喃妥因。结论小儿UTI病原菌仍以大肠埃希菌为常见致病菌,革兰阴性菌感染率有上升趋势,以肺炎克雷伯菌上升最为明显。临床上应重视中段尿的培养,加强对病原菌及其耐药性的监测,以便合理选择敏感抗生素,减少耐药菌的产生。Objective To investigate the pathogen distribution,change and their drug resistance of children with urinary tract infection（UTI）, and to guide the clinical medication. Methods A total of 420 cases of hospitalized children with UTI which were collected from Danyang children′ s hospital in 2011—2015 were analyzed retrospectively. Results A total of 375 strains bacteria were detected,the main was Gram-negative bacteria [92.3%（346/375）],of which the most common was escherichia coli[70.1%（263/375）]. Gram-positive bacteria accouted for 7.7%（29/375）,the common were enterococci faecium 4.3%（16/375）,enterococcus faecalis 1.1%（4/375） and staphylococcus 2.4%（9/375）. Compared the distribution of Gram-positive bacteria and Gram-negative bacteria and the distribution of the top five pathogen in 2011 —2012 and 2013—2015,we found that Gram-negative bacteria infection rate had been higher than Gram-positive bacteria. There was growth trend in Gram-negative bacteria infection compared with the previous two years,klebsiella pneumoniae infection rate was significantly increased（P〈0.05）.In Gram-positive bacteria,the resistant rate of escherichia coli to ampicillin was the highest;it was sensitive to imipenem,meropenem,piperacillin/tazobactam,amikacin,cefoxitin,amoxicillin and clavulanate potassium. The drug resistance of enterococci faecium infection was relatively complex,vancomycin and nitrofurantoin could be chosed for treatment. Conclusion The escherichia coli is still the common pathogenic bacteria in children with UTI. There is an upward trend in Gram-negative bacterial infection,the main is klebsiella pneumoniae. We should pay attention to the cultivation of the middle urine,strengthen the monitoring of pathogens and their drug resistance,in order to rationally choose sensitive antibiotics and reduce the occurrence of drug resistant bacteria.

关 键 词：儿童 泌尿道感染 革兰氏阴性菌 革兰氏阳性菌 抗菌药 药物耐受性 江苏 

分 类 号：R181.34[医药卫生—流行病学]