儿童泌尿系感染大肠埃希菌的耐药性分析

Drug resistance of Escherichia coli strains isolated from children with urinary tract infection

目的了解大肠埃希菌在儿童中的感染情况及其耐药性。方法对中段尿标本进行分离培养及鉴定,药敏试验用K-B法,检测ESBLs用表型确证试验,药敏结果分析用WHONET 5.5软件,统计分析采用X2检验。结果 2009年1月至2011年12月从儿科门诊和病房送检的1 755份中段尿标本中共检出85株大肠埃希菌,检出率为4.8%,男女比为6︰11;<3岁的婴幼儿组57例,占67.1%;3～6岁育龄前儿童17例,占20.0%;>6岁儿童11例,占12.9%;产ESBLs的大肠埃希菌占60.0%;85株大肠埃希菌对亚胺培南和美罗培南全部敏感,对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦和阿米卡星的敏感率均为90%以上,产ESBLs的大肠埃希菌对氨苄西林、头孢唑啉、头孢他啶、头孢曲松、头孢吡肟、头孢西丁、头孢呋新酯、左旋氧氟沙星和罗红霉素的耐药率较非产ESBLs菌株的耐药率高,P值均<0.05,差异有统计学意义。结论儿童泌尿系感染大肠埃希菌,可以选用的抗菌素已极为有限,临床要谨慎用药,并及时根据药敏结果修正药物种类。

Objective To study Escherichia coli infection in children and its resistance.Methods Medistream urine was cultured.Susceptibility test was operated by Kirby-Bauer Method.Extended Spectrum β-lactamases（ESBLs） were detected by Phenotypic confirmatory test.Drug resistance was analysed with WHONET 5.5 software（x2 test）.Results From January 2009 to December 2011,85 Escherichia coli strains were detected in the medstream urine samples from the pediatric clinic and ward,and the detective rate was 4.8%.The ratio of men to women was 6：11;3-year-age group（n=57） accounted for 67.1%;3 to 6-year-age group（n=17） 20.0%;6-year-age group（n=11） 12.9%;ESBLs-producing Escherichia coli 60.0%.85 Escherichia coli strains were sensitive to imipenem and meropenem;the resisitance rates to cefoperazone/sulbactam,piperacillin/tazobactam and amikacin were higher than 90%,and the resistance rates of ESBLs-producing Escherichia coli to ampicillin,cefazolin,ceftazidime,ceftriaxone,cefepime,cefoxitin,cefuroxime,levofloxacin and roxithromycin were significantly higher than non-ESBLs-producing Escherichia coli（P0.05）.Conclusion Antibiotics that can be selected and used to treat children＇s urinary tract infection by Escherichia coli are extremely limited.Careful clinical medication and prompt adjustment of drugs should be based on susceptibility results.