儿童大肠埃希菌泌尿系感染的耐药性监测

Monitoring of Drug Resistance in Pediatric Urinary Tract Infection with Escherichia coli

目的了解湖北地区儿童大肠埃希菌泌尿系感染的耐药特点及现状,为临床诊断与治疗提供科学依据。方法对湖北地区17所三级医院儿童尿培养分离的大肠埃希菌药敏结果进行分析,药敏试验采用K-B法。结果在423株病原菌中,共分离出大肠埃希菌158株,占37.4%,居首位;其中检出产超广谱β-内酰胺酶(ESBLs)菌株112株,占70.9%;其对阿米卡星、呋喃妥因、亚胺培南的敏感率较高,在80.9%～100.0%;对阿莫西林/克拉维酸、头孢哌酮/舒巴坦、氟喹诺酮类及磺胺甲噁唑/甲氧苄啶的敏感率在20.0%～56.0%;产ESBLs株耐药率明显高于非产ESBLs株。结论临床医师需根据药敏结果选用抗菌药物,亚胺培南是治疗产ESBLs大肠埃希菌感染的首选药物。

OBJECTIVE To understand the drug resistance and status in pediatric urinary tract infection with Escherichia coli in Hubei Province and provide the scientific evidence for clinical diagnosis and treatment. METHODS The results of drug susceptibility tests in E. coli isolated from urine samples of children inpatients and outpatients of 17 tertiary level hospitals in Hubei were analyzed. The drug susceptibility tests were performed by K-B method. RESULTS Of 423 pathogenic strains, 158 E. coli accounted for 37. 35% and ranking the top. Among these isolates, 112 extended spectrum β-lactamases （ESBLs）-producing strains were detected, accounted for 70.9%. The most （80. 9-100%） of E. coli were highly susceptible to amikacin, nitrofurantoin and imipenem. The drug suceptibility rate to amoxicillin/clavulanic acid, cefoperazone/sulbactam, quinolones and trimethoprim/ sulfamethoxazole was 20.0-56.0 %. There was significant difference of drug resistance between ESBLs producers and non-ESBLs ones. CONCLUSIONS The clinician should choose individually the antibiotics according to the results of drug susceptibility tests. Imipenem is a preferred antibiotic for treatment of pediatric urinary tract infection with ESBLs-producing E. coli.