2018-2023年北京地区单中心儿童泌尿道感染病原菌分布和耐药率分析  

Pathogenic bacteria distribution and antimicrobial resistance in children with urinary tract infection in a single center in Beijing

作　　者：孙金山[1] 陈朝英[1] 涂娟[1] 耿海云[1] 李华荣[1] 万灵 周林[2] Sun Jinshan;Chen Chaoying;Tu Juan;Geng Haiyun;Li Huarong;Wan Ling;Zhou Lin(Department of Nephrology,Children's Hospital Affiliated to Capital Institute of Pediatrics,Beijing 100020,China;Microbiology Department of Clinical Medical Laboratory,Children's Hospital Affiliated to Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院肾脏内科,北京100020 [2]首都儿科研究所附属儿童医院细菌室,北京100020

出　　处：《中华肾脏病杂志》2024年第12期940-945,共6页Chinese Journal of Nephrology

基　　金：首都儿科研究所青年基金(QN-2024-21)。

摘　　要：目的了解北京地区单中心儿童泌尿道感染(urinary tract infection,UTI)常见病原菌的分布和耐药性,为临床合理使用抗生素提供参考依据。方法该研究为回顾性队列研究,通过回顾性收集2018年6月至2023年6月首都儿科研究所附属儿童医院收治的UTI患儿的临床资料、尿培养病原菌种类和药敏试验结果,参照《UTI诊断与治疗中国专家共识(2015版)——复杂性尿路感染》的诊断标准,根据患儿是否合并复杂因素分为复杂组和单纯组,并分析复杂组患儿的致病因素。采用χ2检验比较两组患儿尿培养病原菌分布,以及大肠埃希菌对常用抗生素耐药率的差异。结果共187例UTI患儿入选该研究,年龄范围为出生后1个月至17岁,中位年龄为8个月,男88例(47.1%),女99例(52.9%),男/女比例为1∶1.125。男性婴儿占男性患儿79.5%(70/88),女性婴儿占女性患儿48.5%(48/99)。单纯UTI组45例(24.1%),复杂UTI组142例(75.9%)。共分离出216株病原菌,以革兰阴性菌为主(151/216,69.9%),其中大肠埃希菌居首位(86/216,39.8%);其次为革兰阳性菌(57/216,26.4%),其中以屎肠球菌(37/216,17.1%)多见。单纯组大肠埃希菌感染阳性率显著高于复杂组[71.1%(32/45)比31.6%(54/171),χ^(2)=23.234,P<0.001],肺炎克雷伯菌、铜绿假单胞菌、屎肠球菌以及真菌感染阳性率低于复杂组,但差异均无统计学意义(均P>0.05)。UTI患儿中大肠埃希菌对氨苄西林的耐药率最高[91.9%(79/86)],对阿米卡星、美罗培南、亚胺培南、哌拉西林/他唑巴坦、头孢吡肟、哌拉西林、头孢唑啉、头孢哌酮/舒巴坦敏感,耐药率分别为5.8%(5/86)、5.8%(5/86)、9.3%(8/86)、10.5%(9/86)、14.0%(12/86)、15.1%(13/86)、18.6%(16/86)和18.6%(16/86)。复杂组患儿大肠埃希菌感染对头孢曲松的耐药率显著高于单纯组,差异有统计学意义[59.3%(32/54)比34.4%(11/32),χ^(2)=4.977,P=0.026]。8株真菌(3.7%)对氟康唑、伏立康唑、伊曲康唑及两性霉素B均敏Objective To investigate the distribution and drug resistance of common pathogens causing urinary tract infection(UTI)in children in Beijing,so as to provide reference for clinical rational use of antibiotics.Methods It was a retrospective cohort study.The results of clinical data,urine culture and drug sensitivity in children with urinary infection treated in the Department of Nephrology,Children's Hospital Affiliated to Capital Institute of Pediatrics from June 2018 to June 2018 were retrospectively analyzed.According to the diagnostic criteria of"Chinese expert consensus on the diagnosis and treatment of UTI(2015 edition)-Complicated urinary tract infection",the children were divided into complex group and simple group according to whether they had complicated factors,and the pathogenic factors of the complex group were analyzed.Theχ^(2) test was used to compare the distribution of pathogenic bacteria in urine culture and the resistance rate of Escherichia coli to common antibiotics between the two groups.Results A total of 187 children with UTI were enrolled in this study.The age ranged from 1 month after birth to 17 years old,and the median age was 8 months.There were 88 males(47.1%)and 99 females(52.9%),and the male/female ratio was 1:1.125.Male infants accounted for 79.5%(70/88)of male infants and female infants accounted for 48.5%(48/99)of female infants.There were 45 cases(24.1%)in the simple UTI group and 142 cases(75.9%)in the complicated UTI group.A total of 216 strains of pathogens were isolated,mainly Gram-negative bacteria(151/216,69.9%),of which Escherichia coli was the most common(86/216,39.8%).The second was gram-positive bacteria(57/216,26.4%),among which Enterococcus faecium(37/216,17.1%)was the most common.The positive rate of Escherichia coli infection in the simple UTI group was significantly higher than that in the complicated UTI group[71.1%(32/45)vs.31.6%(54/171),χ^(2)=23.234,P<0.001],and the positive rate of Klebsiella pneumoniae,Pseudomonas aeruginosa,Enterococcus faecium and fungal

关 键 词：儿童 泌尿道感染 抗菌药 抗药性 病原菌 

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