新生儿泌尿系统感染117例临床分析

Clinical Analysis for 117 Neonates With Urinary Tract Infection

目的探讨新生儿泌尿系统感染(UTI)的临床特点及致病菌的分布和耐药状况。方法对2005年1月至2010年12月成都市妇女儿童中心医院新生儿科病房收治的117例UTI新生儿,按照清洁尿培养结果,将其分为尿培养呈阳性组(A组,n=52)和尿培养呈阴性组(B组,n=65)(本研究遵循的程序符合本院人体试验委员会制定的伦理学标准,得到该委员会批准,分组征得受试对象监护人的知情同意,并与其签署临床研究知情同意书)。两组新生儿性别、胎龄、确诊时日龄及喂养方式等比较,差异无统计学意义(P>0.05)。采用回顾性分析方法,对其临床特点、实验室检查结果、治疗及转归进行统计学分析。结果 117例UTI新生儿的临床表现极不典型,缺乏UTI的局部症状,甚至无症状。52例尿培养呈阳性患儿中,革兰阴性(G-)杆菌检出率为71.15%,分别为大肠埃希菌、阴沟肠杆菌和肺炎克雷伯菌。这些G-杆菌对亚胺培南西司他丁及第三代头孢菌素中头孢哌酮舒巴坦、头孢曲松均敏感。结论 G-杆菌为导致新生儿UTI感染的主要致病菌,临床应重视尿培养以确定病原,合理选用抗菌药物治疗。此外,对患儿进行相应影像学检查以排除其他潜在病因,亦十分必要。

Objective To discuss the clinical features of neonatal urinary tract infection（UTI） and the distribution of the bacteria so as to provide evidence for clinical diagnosis and treatment. Methods From January 2005 to December 2010,117 neonates of UTI were recruited. According to urinary culture results, they were divided into positive group（group A,n：52）and negative group （group B,n=65）. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Chengdu Women and Children＇s Medical Center. Informed consent was obtained from the parents of each participating neonate. There had no significance difference between two groups among gender, gestational ages at delivery, day ages onset time and feeding patterns of neonates （P〉0.05）. Retrospective analytical study were conducted on the clinical manifestations and urinary culture results, and the drug-sensitive results of bacterium coil as well. Results The clinical manifestations of those neonates were not typical. Fifty-two cases among them were urinary culture positive. Gram-negative（G ） bacilli was predominant pathogenic bacteria, accounting for 71.75% of the total. They were Escherichia Coli, Enterobacter Cloacae and Klebsiella Pneumoniae, which were sensitive to imipenem-cilastatin, cefoperazone sulbactam, and ceftriaxone. Conclusion G bacilli were the major pathogen in community acquired pediatric UTI. As the distribution of pathogens and drug resistance, urine culture is worthy of clinical attention. The imaging examination is very important for neonates with UTI.