小儿尿路感染的常见病因及临床特点研究  

Common causes and clinical characteristics of urinary tract infection in children

作　　者：吴忠[1] 韩宇 李海珠 史广义 赵振东[2] WU Zhong;HAN Yu;LI Hai-zhu;SHI Guang-yi;ZHAO Zhen-dong(Hainan Maternal and Child Health Care Hospital,Haikou,Hainan 570206,Chin)

机构地区：[1]海南省妇幼保健院外科,海南海口570206 [2]海南省妇幼保健院检验中心,海南海口570206

出　　处：《中华医院感染学杂志》2018年第13期2040-2043,共4页Chinese Journal of Nosocomiology

基　　金：海南省卫生计生委基金资助项目(1601032027A2001)

摘　　要：目的研究和分析小儿尿路感染的常见病因及临床特点,为临床感染的诊断和治疗工作提供客观依据。方法选取2015年6月-2017年6月的315例尿路感染患儿作为研究对象,对患儿的主要临床表现、病因及尿液样本中的病原菌分布及耐药性进行回顾性研究和分析。结果尿路感染患儿的临床症状以发热、尿道感染征、腹泻、上呼吸道症状为主,发生率分别为66.67%、36.83%、36.35%、22.86%。在患儿的病因类型中,单纯型169例占53.65%,复杂型146例占46.35%,复杂型病因中以原发性肾病、膀胱输尿管返流、神经性膀胱、包茎等原因为主,分别占17.14%、7.62%、4.76%、4.76%。在患儿尿液样本中共分离出336株病原菌,其中,革兰阴性菌286株占85.12%,革兰阳性菌45株占13.39%,真菌5株占1.49%,大肠埃希菌、粪肠球菌、奇异变形杆菌、肺炎克雷伯菌为主要病原菌,构成比分别为68.75%、7.14%、6.55%和5.06%。革兰阴性菌对氨苄西林、头孢唑林、环丙沙星、磺胺甲噁唑/甲氧苄啶、左旋氧氟沙星、庆大霉素的耐药率较高,>60%,对亚胺培南、头孢哌酮/舒巴坦较为敏感,耐药率<15%。革兰阳性菌对青霉素G、苯唑西林、庆大霉素、红霉素、磺胺甲噁唑/甲氧苄啶、头孢噻肟等的耐药率较高,>60%,对亚胺培南较敏感,耐药率<35%。结论小儿尿路感染的临床表现、常见病因、主要病原菌及耐药性具有一定的特征性,临床医生应给予密切的关注,及时进行病因及病原学诊断并给予有效的治疗,以提高治疗效果、减少并发症、改善患儿的预后。OBJECTIVE To investigate the common causes and clinical characteristics of urinary tract infection in children so as to provide objective basis for clinical diagnosis and treatment of the infection.METHODS A total of315 children with urinary tract infection who were treated from Jun 2015 to Jun 2017 were recruited as the study objects.The major clinical manifestations,causes of diseases and distribution and drug resistance of pathogens isolated from urine specimens were retrospectively observed.RESULTS The fever,urinary tract infection syndrome,diarrhea and upper respiratory tract syndrome were the major clinical symptoms of the children with urinary tract infection,and the incidence rates were 66.67%,36.83%,36.35% and 22.86%,respectively.The etiologic analysis showed that there were 169（53.65%）cases of simple type and 146（46.35%）cases of complex type.Among the patients with the complex causes,17.14% had primary nephropathy,7.62% had vesicoureteral reflux,4.76%had neurogenic bladder,and 4.76% had phimosis.Totally 336 strains of pathogens were isolated from the urine specimens of the children,286（85.12%）of which were gram-negative bacteria,45（13.39%）were gram-positive bacteria,and 5（1.49%）were fungi.Escherichia coli,Enterococcus faecalis,Proteus bacillus,and Klebsiella pneumoniae were the predominant species of pathogens,accounting for 68.75%,7.14%,6.55% and 5.06%,respectively.The drug resistance rates of the gram-negative bacteria to ampicillin,cefazolin,ciprofloxacin,trimethoprim-sulfamethoxazole,levofloxacin and gentamicin were more than 60%,the drug resistance rates to imipenem and cefoperazone-sulbactam were less than 15%.The drug resistance rates of the gram-positive bacteria to penicillin G,oxacillin,gentamicin,erythromycin,sulfamethoxazole-trimethoprim and cefotaxime were more than60%,and the drug resistance rate to imipenem was less than 35%.CONCLUSIONThe children with urinary tract infection are characterized by the clinical manifestations,common causes,major species of pathogens and

关 键 词：小儿 尿路感染 病因 病原菌分布 耐药性分析 

分 类 号：R691.3[医药卫生—泌尿科学]