新生儿尿路感染临床特点与尿培养阳性菌株分布及耐药性分析  

Clinical Characteristics of Urinary Tract Infection,Distribution of Urine Culture Positive Strains and the Drug Resistance in Newborns

作　　者：沈安英[1] 孙节[1] 程瑶[1] 蒋延华 Shen Anying;Sun Jie;Cheng Yao;Jiang Yanhua(Jinshan Branch of Shanghai the Sixth People＇s Hospital,Shanghai Jinshan 201599,China)

机构地区：[1]上海市第六人民医院金山分院,上海金山201599

出　　处：《儿科药学杂志》2018年第11期42-45,共4页Journal of Pediatric Pharmacy

摘　　要：目的:探讨新生儿尿路感染临床特点、尿培养阳性菌株分布及常见细菌耐药性。方法:回顾性分析178例新生儿尿路感染患儿的临床特点、尿培养、药敏结果、辅助检查及治疗情况。结果:178例新生儿尿路感染以黄疸为主要临床表现,男女比例1. 92∶1。尿培养革兰阴性杆菌以大肠埃希菌为主,革兰阳性菌以屎肠球菌为主。108株大肠埃希菌中检出产超广谱β-内酰胺酶(ESBLs) 45株,占41. 7%。19株肺炎克雷伯菌中产ESBLs 11株,占57. 9%。产ESBLs株对含β-内酰胺酶抑制剂的复合制剂、碳青霉烯类敏感率高。非产ESBLs对第三代头孢菌素敏感率较高,对氨苄西林普遍耐药,对亚胺培南均敏感。屎肠球菌对青霉素、红霉素及氨苄西林等耐药性均>84%。结论:新生儿尿路感染以黄疸为主要表现,不明原因黄疸新生儿尿培养值得重视。尿培养病原菌以革兰阴性菌为主,肠球菌及产ESBLs株增多,不同细菌有不同程度耐药,应根据药敏试验结果并结合本地区耐药性变迁合理使用抗菌药物。Objective： To probe into the clinical characteristics of urinary tract infection,the distribution of urine culture positive strains and the drug resistance of common bacteria in newborns. Methods： Totally 178 newborns with urinary tract infarction were retrospectively analyzed in terms of clinical characteristics,urine culture,drug sensitivity test,auxiliary examination and treatment.Results： The clinical manifestations of 178 cases of neonatal urinary tract infection were mainly jaundice,with a ratio of male to female of 1.92 ∶ 1. Gram negative bacteria in urine culture were mainly escherichia coli,and gram positive bacteria were mainly enterococcus faecium. Totally 45 strains of extended-spectrum β-lactamase（ ESBLs） were detected from 108 strains of escherichia coli,accounting for41.7%. Eleven strains of ESBLs were detected from 19 strains of klebsiella pneumoniae,accounting for 57.9%. The ESBLs strain had high antibiotic sensitive rates to composite preparations containing β-lactamase inhibitor and carbapenems. Non-ESBLs strains were more sensitive to the third-generation of cephalosporins,generally resistant to ampicillin and sensitive to imipenem. All the resistances of enterococcus faecium to penicillin,erythromycin and ampicillin were more than 84%. Conclusion： Neonatal urinary tract infection is mainly characterized by jaundice,unexplained jaundice neonatal urinary culture should be payed attention. The pathogens of urine culture are mainly gram negative bacteria,and the numbers of enterococci and ESBLs strains have been increased. Different bacteria have different degrees of drug resistance,antibiotics should be rationally applied according to drug sensitivity test,with the combination of drug resistance changes in this area.

关 键 词：新生儿 尿路感染 尿培养 病原学 耐药性 

分 类 号：R722.1[医药卫生—儿科]