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目的了解儿童泌尿系感染(UTI)的临床特点、常见病原菌分布及耐药现状,为临床用药提供依据。方法分析本院2000年1月-2007年2月住院的UTI患儿临床资料和尿培养结果,结合几种常见革兰阴性杆菌的药敏试验进行耐药性分析。结果本组确诊UTI的98例患儿中<1岁者29例(30%);无典型UTI阳性症状者19例(19.4%);泌尿系影像学检查异常者32例(32.7%);泌尿道畸形、输尿管狭窄或伴膀胱输尿管返流(VUR)者11例(11.2%)。尿标本共培养分离出病原菌105株,其中革兰阴性菌84株(80.0%),革兰阳性菌17株(16.2%),真菌4株(3.8%)。革兰阴性菌以大肠埃希菌、肺炎克雷伯杆菌、铜绿假单胞菌为主,革兰阳性菌以肠球菌和葡萄球菌为主。55株大肠埃希菌中分离出33株产超广谱β-内酰胺酶菌株(60%)。氨苄西林、头孢唑啉等对革兰阴性菌严重耐药,辅以酶抑制剂(如舒巴坦或甲巯咪唑)后耐药率明显降低;三代头孢菌素对铜绿假单胞菌敏感性良好,而对大肠埃希菌、肺炎克雷伯杆菌呈现中等耐药;亚胺培南、阿米卡星和环丙沙星耐药率最低。结论UTI患儿中小婴儿发病率较高,应高度警惕泌尿道畸形、输尿管狭窄或VUR等并发症的发生,对反复UTI患儿影像学检查必不可少。最常见病原菌为大肠埃希菌,且耐药现象严重,应根据药敏试验针对性选择抗生素,规范用药。
Objective To understand the clinical features of children with urinary tract infection (UTI), the distribution of common pathogens and drug resistance status, to provide the basis for clinical medication. Methods The clinical data and urine culture results of hospitalized UTI children from January 2000 to February 2007 in our hospital were analyzed. The drug resistance of several common Gram-negative bacilli were analyzed with drug susceptibility test. Results In the group of 98 patients diagnosed with UTI, 29 cases (30%) were less than 1 year old, 19 cases (19.4%) had no typical UTI positive symptoms, 32 cases (32.7%) had abnormal urine imaging examination, Eleven patients (11.2%) had deformity, ureteral stricture, or vesicoureteral reflux (VUR). 105 strains of pathogens were isolated from urine samples, of which 84 (80.0%) were Gram-negative bacteria, 17 (16.2%) were Gram-positive bacteria and 4 (3.8%) were fungi. Gram-negative bacteria to Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa-based, Gram-positive bacteria to enterococci and staphylococcus-based. Seventy-three ESBLs isolates (60%) were isolated from 55 isolates of Escherichia coli. Ampicillin, cefazolin and other Gram-negative bacteria on the serious resistance, with enzyme inhibitors (such as sulbactam or methimazole) was significantly lower drug resistance; third-generation cephalosporins Pseudomonas aeruginosa sensitivity Good, and Escherichia coli, Klebsiella pneumoniae showed moderate resistance; imipenem, amikacin and ciprofloxacin lowest resistance rate. Conclusion The incidence of small and medium-sized infants in children with UTI is higher. We should be highly vigilant in the occurrence of complications such as urinary tract deformity, ureteral stricture or VUR, which is essential for the imaging examination of children with UTI. The most common pathogen is Escherichia coli, and drug resistance is serious, should be based on susceptibility testing targeted antibiotics, standardized medication.