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目的:研究儿童急性肾盂肾炎致病菌及耐药性特点,并为该病的临床治疗方案积累经验,以提高治愈率.方法:收集我院2015年1月～2017年10月134例儿童急性肾盂肾炎患者,分析病原菌特点及其耐药性,记录在院期间抗菌药物使用情况及其治疗结果.结果:134例患者(152例标本)共检出病原菌64株(51株做过药敏试验),以大肠埃希菌为主(21株,32.81％),其中12株为产超广谱β-内酰胺酶(ESBLs)菌株,9株为非产ESBLs菌株.其次为屎肠球菌(14株,21.88％)、粪肠球菌(11株,17.19％)、肺炎克雷伯菌(4株,6.25％,其中有3株为产ESBLs菌株).产ESBLs菌株对头孢菌素基本耐药,对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦的耐药率相对较低.肠球菌对红霉素的耐药率为100％,对万古霉素、磷霉素、利奈唑胺、替考拉宁等的耐药率较低.对氨苄西林的耐药率为70％ (35/50),产ESBLs菌株和屎肠球菌对其100％耐药,耐药情况不容乐观.对碳青霉烯类药物的耐药性处于较低水平.我院临床上使用的抗菌药物以三代头孢菌素(头孢克肟、头孢曲松)为主,耐药率较低的头孢哌酮/舒巴坦、氨苄西林/他唑巴坦也是用药频次较大的抗菌药物.134例患者出院时11例治愈,123例好转.结论:大肠埃希菌、粪肠球菌、屎肠球菌是儿童急性肾盂肾炎的三种主要病原菌.对于儿童急性肾盂肾炎患者,临床治疗应首选三代头孢菌素.对于产ES-BLs菌株,在头孢菌素效果不好的情况下给予碳青霉烯类及含舒巴坦或他唑巴坦复合制荆较为合适.“,”Objective:To explore the distribution and drug resistance of pathogens causing acute pyelonephritis in children patients and accumulate experience for clinical treatment of the disease so as to improve the cure rate.Methods:A total of 134 children patients with acute pyelonephritis,who were treated in our hospital from January 2015 to October 2017.The characteristics and drug resistance of the pathogenic bacteria were retrospectively analyzed.Record of the use of antibiotic and the results of their treatment during the period of the hospital.Results:Totally 64 strains of pathogens have been isolated form the 152 specimens of 134 children patients (susceptibility testing done 51),among which 21 (32.81％) strains of Escherichia coli were dominant,of which 12 were ESBLs-producing strains,9 were non-ESBLs-producing strains.Followed by 14 strains of Enterococcusfaecium (21.88％);11 strains of Enterococcusfaecalis (17.19％);4 strains of Klebsiella pneumonia (6.25％),of which 3 strains were ESBLs-producing strains;ESBLs producing strains resistant to cephalosporin,cefoperazone sodium and sulbactam,piperacillin and tazobactam resistance rate was relatively low.Enterococcus resistance to erythromycin was up to 100％,vancomycin,fosfomycin,linezolid,teicoplanin resistance rates were very low.Ampicillin resistance rate was 70％,ESBLs-producing strains and Enterococcus faecium was 100％ resistant to it.The resistance of carbapenems was temporarily at a low level.The third-generation of cephalosporin (cefixime and cefatriaxone) was the main antibiotics used in our hospital.Cefoperazone and sulbactam,ampicillin and tazobactam were the most frequently used antibiotics.Of the 134 patients who were discharged,11 cases were cured and 123 were improved.Conclusion:Escherichia coli,Enterococcus faecium and Enterococcus faecalis are the three main pathogens of acute pyelonephritis in children.The composition ratio of Enterococcus in the pathogens of urinary tract infection is increasing.Combined with clinical practice for children with acute pyelonephritis patients,third generation cephalosporin is preferred.For the treatment of ESBLs-producing strains in the case of third generation cephalosporins ineffective given carbapenems and sulbactam or tazobactam compound preparation is more appropriate.