单纯泌尿道感染与肾病综合征并发泌尿道感染患儿的病原菌及其耐药性分析

Analysis of pathogen and anti-microbial resistance in children with urinary tract infection and nephrotic syndrome accompanied by urinary tract infection

目的了解单纯泌尿道感染(UTI)和肾病综合征(NS)合并UTI患儿的菌群、药物敏感性和耐药性的差异。方法收集单纯UTI与NS合并UTI患儿的临床资料和中段尿培养结果并进行回顾性分析。结果 44例单纯UTI患儿中,有症状者35例(79.55%);52例NS并发UTI患儿中,有症状者31例(59.62%),两组差异有统计学意义(P<0.05)。44例单纯UTI患儿中培养出44株病原菌,52例NS并发UTI患儿中培养出53株病原菌;大肠埃希菌在单纯UTI和NS合并UTI中均为优势菌群,其分离率在两者间差异无统计学意义(P>0.05),而单纯UTI患儿的球菌分离率(7/44,15.91%)低于NS合并UTI患儿(18/53,33.96%),差异有统计学意义(P>0.05)。单纯UTI患儿与NS并发UTI患儿所分离的大肠杆菌对常用抗生素耐药率均较高。结论与单纯UTI患儿相比,NS并发UTI患儿的临床症状常不典型,以无症状菌尿为多见,致病菌以革兰阴性杆菌为主,耐药率高;革兰阳性球菌感染有上升趋势;提示在尿培养结果出来之前,应首选含酶抑制剂抗生素治疗。

Objective To study the differences in pathogen, antimicrobial resistance between children with urinary tract infection （UTI） and nephrotic syndrome （NS） accompanied by UTI. Methods The clinical data and the results of midstream urine culture were collected and analyzed from children with UTI and NS accompanied by UTI. Results Among 44 UTI children and 52 NS children accompanied by UTI, there were 35 （79.55%） and 31 （59.62%） children had symptoms, respectively, and the difference was statistically significant （P〈0.05）. Forty-four pathogenic strains and 53 pathogenic strains were isolated from blood samples obtained from 44 UTI children and from 52 NS children accompa- nied by UTI, respectively. Escherichia coli was the dominant bacterial community in both UTI children and NS children accompanied by UTI, and the difference in isolation rate between two groups was not significant （P〉0.05）. However, the cocci isolation rate in UTI children （15.91%） was significantly lower than that in NS children accompanied by UTI （33.96%） （P〈0.05）. The drug resistance ofEscherichia coli was high isolated from both UTI children and NS children accompanied by UTI. Conclusions Compared with UTI children, the clinical manifestations of NS children accompanied by UTI were not typical. Asymptomatic bacteriuria was common and gram-negative bacilli were the dominant pathogenic bacteria with high antimicrobial resistance in NS children accompanied by UTI. The infection rate of gram-positive cocci was increased. So prior to the results of urine culture, the antibiotics with enzyme depressor should be chosen first.