儿童神经源性膀胱并尿路感染43例临床分析  

Clinical features of 43 cases of neuropathic bladder with urinary tract infection in children

作　　者：周广伦[1] 尹鉴淳[1] 刘晓东[1] 姜俊海[1] 李守林[1] ZHOU Guang-lun;YIN Jian-chun;LIU Xiao-dong;JIANG Jun-hai;LI Shou-lin(Department of Urinary Surgery,Shenzhen Children's Hospital,Shenzhen 518034,Guangdong,CHINA)

机构地区：[1]深圳市儿童医院泌尿外科,广东深圳518034

出　　处：《海南医学》2020年第22期2935-2938,共4页Hainan Medical Journal

基　　金：国家自然科学基金(编号:U1904208);广东省深圳市卫生计生系统科研项目(编号:SZXJ2018045)。

摘　　要：目的探讨儿童神经源性膀胱并尿路感染的临床特点。方法回顾性总结分析2010年1月至2020年5月深圳市儿童医院泌尿外科收治的43例儿童神经源性膀胱并尿路感染患儿的临床资料。结果43例患儿中男性20例,女性23例;32例(74.4%)反复感染(≥3次);临床症状以发热(50.9%)为主,部分(32.5%)为尿频尿痛和腹痛,消化道不适和异常哭闹较少见;43例患儿共住院114人次,培养出108例菌株,其中革兰阴性菌77株,阳性菌22株,真菌9株;大肠埃希菌30株,检出产超广谱β-内酰胺酶(ESBLs)22株(70.3%),14株肺炎克雷伯菌中产ESBLs 10株(71.4%);革兰阴性菌对头孢克洛、头孢呋辛、氨苄西林耐药率≥78%,对头孢曲松耐药率≥50%,对哌拉西林/他唑巴坦、美罗培南及亚胺培南等敏感率≥92.9%;屎肠球菌对青霉素、阿莫西林克拉维酸钾、氨苄西林及克林霉素的耐药率≥70%;选用哌拉西林/他唑巴坦抗感染治愈43例,经头孢呋辛钠治疗无效改用哌拉西林/他唑巴坦治愈16例,碳青霉烯类和万古霉素治愈10例。结论尿路感染是导致神经源性膀胱患儿反复住院的常见原因,其临床表现多样,反复感染比例高。病原菌以革兰阴性菌为主,产ESBLs菌株比例高,对头孢唑林和头孢呋辛钠等第一、二代头孢菌素耐药率较高,对酶抑制剂哌拉西林/他唑巴坦和碳青霉烯类抗生素敏感性高。屎肠球菌耐药严重,应引起临床重视。Objective To investigate the clinical features of neuropathic bladder with urinary tract infection in children.Methods The clinical data of 43 children with neuropathic bladder with urinary tract infection hospitalized in Department of Urinary Surgery,Shenzhen Children's Hospital from January 2010 to May 2020 were retrospectively analyzed.Results There were 20 males and 23 females in 43 children.Thirty-two cases(74.4%)had recurrent infection(≥3 times).The main clinical symptoms were fever(50.9%),followed by frequent urination and abdominal pain(32.5%).The gastrointestinal discomfort and abnormal crying were rare.A total of 108 strains have been cultured from the submitted specimens obtained from the 43 patients,including 77 strains of Gram-negative bacteria,22 strains of Gram-positive bacteria,and 9 strains of fungi.A total of 22 extended spectrumβ-lactamases(ESBLs)-producing bacteria were detected in 30 strains of Escherichia coli(70.3%),and 10 ESBLs-producing bacteria were detected in 14 strains of Klebsiella neumoniae(71.4%).The drug resistant rates of Gram-negative bacteria to cefaclor,ampicillin,and cefuroxime sodium were≥78%,and that to ceftriaxone was≥50%.The sensitive rates of Gram-negative bacteria to piperacillin tazobactam,meropenem,and imipenem were≥92.9%.The drug resistance rates of Enterococcus faecium to penicillin,amoxicillin,clavulanate potassium,ampicillin,and clindamycin were≥70%.Forty-three cases were cured by the piperacillin/tazobactam,16 cases showed poor response to cefuroxime sodium treatment were then cured by piperacillin/tazobactam,and 10 cases were cured by carbapenems and vancomycin.Conclusion Urinary tract infection is a common cause of repeated hospitalization in children with neurogenic bladder,which has various clinical manifestations and high proportion of recurrent infection.The pathogens were dominantly Gram-negative bacteria,which have a high proportion of ESBLs-producing strains.They were highly resistant to the first and second generation cephalosporins such as c

关 键 词：复杂性尿路感染 神经源性膀胱 耐药性 病原菌 儿童 诊断 感染 

分 类 号：R694[医药卫生—泌尿科学]