新生儿泌尿系感染66例临床分析

The clinical analysis of 66 neonates with urinary tract infection

目的总结新生儿泌尿系感染的临床特点及诊治经过。方法回顾分析66例新生儿泌尿系感染患儿的临床资料。结果本组患儿最常见的临床表现为发热、皮肤黄染和咳嗽、气促、喉中痰响等呼吸系统症状及腹胀、吐奶、腹泻等消化系统症状。最常见的基础疾病为肺炎、高胆红素血症、败血症。泌尿系彩超阳性率为26.7%。尿培养阳性率为56.9%,居于前三位的病原菌为屎肠球菌、大肠埃希菌、肺炎克雷伯菌。屎肠球菌对万古霉素、利奈唑烷敏感,对青霉素、红霉素、氯洁霉素、喹诺酮类抗生素耐药。大肠埃希菌及肺炎克雷伯菌对亚胺培南敏感,对普通青霉素及大部分头孢类抗生素耐药率高。结论新生儿泌尿系感染临床表现不典型,多以全身症状为主,因此应加强尿常规筛查,必要时行尿培养及肾脏彩超检查。屎肠球菌及大肠埃希菌为其最常见的病原菌,临床医生应参照尿培养药敏试验选择敏感抗生素治疗。

Objective To discuss the clinical features, diagnosis and treatment of choice in neonates with urinary tract infection. Methods Analyzed and summarized the clinical data of 66 neonates with urinary tract infection. Results The most common clinical features of these children include fever,jaundice ,symptoms of respiratory system such as cough, tachypnea and sound of sputum, and symptoms of gastrointestinal system such as ventosity, vomiting, and diarrhea. Pneumonia,jaundice and septicemia were the main base diseases. The positive rate of renal ultrasound was 26.7%. The positive rate of urine culture was 56.9%. The top three pathogens are Enterococcus feces, Escherichia coli, and Klebsiella pneumonia. Enterococcus feces were sensitive to vancomycin and linezolid, but resistant to penicillin, ery- thromycin, clindamycin and quinolone antibiotics. Escherichia coli and Klebsiella pneumonia were sensitive to imipen- era,but resistant to penicillin and most cephalosporins antibiotics. Conclusion Clinical manifestations of neonatal uri- nary tract infection are often atypical and presented as systemic symptoms. Urinalysis must be performed in every neonate with urinary tract infection. Renal ultrasound and urine culture can be done if needed. The most common pathogens are Enterococcus feces and Escherichia coli. Drug administration should be based on the results of drug sensitivity tests.