西安地区儿童尿路感染的临床特点及病原菌分析  

Clinical characteristics and pathogenic analysis of children with urinary tract infection in Xi′an area

作　　者：刘晓晓 刘仲伟[2] 朱海涛 李汶静 吕光伟 薛继红 LIU Xiaoxiao;LIU Zhongwei;ZHU Haitao;LI Wenjing;LYU Guangwei;XUE Jihong(The Third Ward of Pediatrics,Northwest Women and Children′s Hospital,Xi′an,Shaanxi 710061,China;Department of Cardiovascular Medicine,Shaanxi Provincial People′s Hospital,Xi′an,Shaanxi 710000,China;Department of Urology,Northwest Women and Children′s Hospital,Xi′an,Shaanxi 710061,China)

机构地区：[1]西北妇女儿童医院儿内科三病区,陕西西安710061 [2]陕西省人民医院心血管内科,陕西西安710000 [3]西北妇女儿童医院泌尿外科,陕西西安710061

出　　处：《检验医学与临床》2023年第16期2305-2308,2315,共5页Laboratory Medicine and Clinic

基　　金：国家自然科学基金面上项目(82070858)。

摘　　要：目的分析西安地区尿路感染(UTI)患儿的临床特点、常见病原菌及其耐药情况。方法选择2017年1月至2021年12月西北妇女儿童医院收治的433例UTI患儿为研究对象,根据年龄将433例UTI患儿分为婴儿组(29 d至1岁)、幼儿组(1~<3岁)、儿童组(3~12岁)。回顾性分析患儿临床表现、影像学检查结果、病原学检测结果等信息。结果UTI患儿中,婴儿组以发热为主要临床表现者比例为85.81%,明显高于幼儿组的68.75%及儿童组的39.39%,差异均有统计学意义(χ^(2)=52.228,P<0.001;χ^(2)=6.868,P=0.009)。而儿童组以尿路刺激征者最为多见,其比例为48.48%,与婴儿组的3.12%及幼儿组的18.75%比较,差异均有统计学意义(χ^(2)=88.366,P<0.001;χ^(2)=8.103,P=0.004)。彩超检查结果发现泌尿系统异常者115例,检出率为26.5%。433份尿培养标本共培养出病原菌122株,检出率为28.17%,其中革兰阴性菌67株(54.92%),以大肠埃希菌为主,革兰阳性菌55株(45.08%),以屎肠球菌为主。大肠埃希菌耐药率80.00%以上的药物依次为氨苄西林、头孢呋辛、哌拉西林、头孢唑林,敏感药物依次为美罗培南、亚胺培南、阿米卡星、哌拉西林/他唑巴坦、呋喃妥因、头孢替坦、头孢吡肟、氨曲南、头孢他啶、妥布霉素。屎肠球菌耐药率70.00%以上的药物依次为红霉素、氨苄西林、青霉素G,敏感药物依次为利奈唑胺、万古霉素、替加环素、呋喃妥因。结论临床上婴幼儿UTI以发热为主要临床表现,而儿童以尿路刺激征为主要临床表现。大肠埃希菌仍然是儿童UTI的主要致病菌,革兰阳性菌以屎肠球菌为主。不同病原菌对抗菌药物的敏感性存在差异,应根据病原菌培养及药敏试验结果合理使用抗菌药物。Objective To analyze the clinical features,common pathogens and drug resistance of children with urinary tract infection(UTI)in Xi′an area.Methods A total of 433 children with UTI admitted to the Northwest Women and Children′s Hospital from January 2017 to December 2021 were selected as the study objects.According to age,433 children with UTI were divided into infant group(29 d to 1 year old)young children group(1-<3 years old)and child group(3-12 years old).The clinical manifestations,imaging findings,etiology findings and other information were analyzed retrospectively.Results Among the UTI children,fever was the main clinical manifestation in the infant group with 85.81%,which was significant higher than 68.75%in the young children group and 39.39%in the children group(χ^(2)=52.228,P<0.001;χ^(2)=6.868,P=0.009).Urinary tract irritation was the most common in the children group(48.48%),which was significantly different from 3.12%in the young children group and 18.75%in the infant group(χ^(2)=88.366,P<0.001;χ^(2)=8.103,P=0.004).Color ultrasonography found 115 cases with abnormal urinary system,the detection rate was 26.5%.A total of 122 strains of pathogenic bacteria were cultured from 433 samples,the detection rate was 28.17%,among which 67 strains(54.92%)were gram-negative,mainly E.coli,55 strains(45.08%)were gram-positive,mainly E.faecium.The drugs with more than 80.00%resistance rate of E.coli were ampicillin,cefuroxime,piperacillin and ceftazolin in order,and the sensitive drugs were meropenem,imipenem,amicacin,piperacillin/tazobactam,furantoin,cefotetan,cefepime,amtraxam,ceftazidine,Tobramycin in order.The drugs with more than 70.00%resistance rate of E.faecium were erythromycin,ampicillin and penicillin G,and the sensitive drugs were linezolid,vancomycin,tegecycline and furantoin.Conclusion Fever is the main clinical manifestation of UTI in infants,and urinary tract irritation is the main clinical manifestation in children.E.coli is still the main cause of UTI in children,and the gram-positive bact

关 键 词：尿路感染 儿童 临床特点 病原菌 药敏试验 

分 类 号：R446.5[医药卫生—诊断学]