难治性肾病综合征患儿尿路感染病原菌分布与耐药性分析

Distribution and drug resistance of pathogens causing urinary tract infection in children with refractory nephrotic syndrom

目的了解儿童难治性肾病综合征伴尿路感染病原菌的分布及其耐药性,为临床合理治疗提供依据。方法对医院2007年1月-2009年12月送检的142份难治性肾病综合征患儿尿液进行培养及鉴定,用K-B法做药敏试验,用表型确证试验测定超广谱β-内酰胺酶,并对结果进行回顾性分析。结果 70份阳性标本中共检出76株病原菌,最常见的为大肠埃希菌28株,占36.85%,其次是肠球菌属14株,占18.42%;肠杆菌科细菌对亚胺培南、呋喃妥因和哌拉西林/他唑巴坦有良好的敏感率;肠球菌属则对万古霉素100.00%敏感。结论大肠埃希菌仍为难治性肾病综合征尿路感染最常见的病原菌,而革兰阳性菌所占比例较普通尿路感染者为高,对常用药物如氨苄西林、三代头孢菌素等已产生较高的耐药性,临床医师应根据药敏结果合理应用抗菌药物。

OBJECTIVE To investigate the distribution and drug resistance of pathogens in urinary system infection with refractory nephrotic syndrome（RNS）.METHODS A total of 142 urine specimens collected from RNS patients of our hospital during Jan 2007 to Dec 2009 were cultured and detected the d drug-resistance.Susceptibility test was taken by Kirby-Bauer method.Extended-spectrum β-lactamases（ESBLs） were detected by double-disc synergy test.RESULTS All of 76 pathogens were isolated in 70 specimens,Escherichia coli was the most common pathogen（36.85%）,followed by Enterococcus（18.42%）.The Enterobacteriaceae were sensitive to imipenem,nitrofurantoin and topiperacillin/tazobactam.The Enterococcus were sensitive to vancomycin（100.00%）.CONCLUSIONS E.coli is still the most common pathogen in urinary tract infection with RNS,but the rate of G＋ cocci infection is higher than the common.It should pay attention to fungal and Acinetobacter baumannii infection in the patients who had used glucocorticoid and immunosuppressant for more than two years.The commonly used drugs such as ampicillin,the third generation cephalosporin,etc,have produced a higher resistance.Clinician should pay attention to the pathogens detection and drug resistance and use antimicrobials correcttly according to the result of drug-sensitivity.