无锡市1003例泌尿道感染患儿临床及病原菌分析  

Clinical and pathogenic bacteria analysis of 1003 children with urinary tract infection in Wuxi

作　　者：姚瑶 赵丽萍[1] 周红霞[1] 葛婷婷[1] 张林[1] 刘宇立 朱国琴 徐锦雯[1] 刘洵薇 吴晴[1] 成芸 杨玲云 安娜 葛令清 YAO Yao;ZHAO Li-ping;ZHOU Hong-xia;GE Ting-ting;ZHANG Lin;LIU Yu-li;ZHU Guo-qin;XU Jin-wen;LIU Xun-wei;WU Qing;CHENG Yun;YANG Ling-yun;AN Na;GE Ling-qing(Department of Pediatric Nephrology,Wuxi Children’s Hospital,Wuxi 214023,China)

机构地区：[1]无锡市儿童医院儿肾内科,无锡214023

出　　处：《临床肾脏病杂志》2020年第2期104-108,共5页Journal Of Clinical Nephrology

摘　　要：目的探讨无锡地区泌尿道感染患儿临床特点及常见病原菌、耐药情况。方法对2016年1月至2018年12月无锡市儿童医院肾内科收治的1003例泌尿道感染患儿的临床资料、尿液细菌培养试验、药敏试验结果进行回顾性分析,数据应用SPSS 20.0统计学软件分析。结果小儿泌尿道感染以3岁以下女孩多见。泌尿道感染患儿临床上多合并呼吸道感染(65.70%)、尿路结构异常(33.60%)、脓毒症(9.37%)、腹泻病(8.47%)等。1003例患儿检出病原菌共191株(19.04%),革兰阴性菌为111例(58.12%),其中大肠埃希菌最多见,共75例(39.27%);革兰阳性菌78例(40.84%),以屎肠球菌为主,共43例(22.51%)。无尿路结构异常者与伴有尿路结构异常者的主要病原菌比较差异无统计学意义(χ^2=2.616,P>0.05)。大肠埃希菌对氨苄西林、头孢唑林、头孢曲松耐药率均在70%以上,而对亚胺培南、呋喃妥因、哌拉西林/他唑巴坦、头孢替坦、头孢吡肟、头孢他定耐药率低。屎肠球菌对氨苄西林、克林霉素、红霉素耐药率均在60%以上,而对万古霉素、利奈唑胺及呋喃妥因耐药率低。结论临床上以发热、呼吸道感染症状首诊的患儿,尤其婴幼儿,注意鉴别泌尿道感染。泌尿道感染患儿仍以大肠埃希菌为常见致病菌,但肠球菌的检出率近年来增加,应当重视中段尿培养。Objective To investigate the clinical features,common pathogens and their drug resistance in children with urinary tract infection in Wuxi area.Methods The clinical and urinary bacteria culture test and drug susceptibility test results of 1003 children with urinary tract infections admitted to our nephrology department from January 2016 to December 2018 were retrospectively analyzed.The data were analyzed by SPSS 20.0 statistical software.Results Urinary tract infection in children was more common in girls less than 3 years old.65.70%of the children with urinary tract infection were complicated with respiratory tract infections,33.60%with abnormal urinary tract structure.9.37%with sepsis,8.47%with diarrhea,etc.In addition,191 strains(19.04%)of pathogens were detected in 1003 patients.Among the cases,111 ones were related to Gram-negative bacteria,(58.12%),and Escherichia coli ranked first with 75 cases(39.27%);78 ones(40.84%)to Gram-positive bacteria,of which Enterococcus faecium was dominantwith 43 cases(22.51%).There was no significant difference in pathogenic bacteria between patients with normal urinary tract and abnormal urinary tract(χ2=2.616,P>0.05).The resistance rates of Escherichia coli to ampicillin,cefazolin and ceftriaxone were all over 70%,while the resistance rates to imipenem,furantoin,piperacillin/tazobactam,ceftitam,cefepime and ceftazidime were low.Enterococcus faecium had a resistance rate of more than 60%to ampicillin,clindamycin and erythromycin,but less resistant to vancomycin,linezolid and furantoin.Conclusions Children with fever and respiratory tract infection diagnosed first,especially infants,should pay attention to the identification of urinary tract infection.Escherichia coli is still a common pathogen in children with urinary tract in-fections.The detection rate of Enterococcus has increased in recent years,and more attention should be paid to bacterial culture of mid-stream urine.

关 键 词：泌尿道感染 儿童 病原菌 药敏试验 

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