新生儿尿路感染临床特点及病原菌耐药趋势分析

Analysis of clinical characteristics and pathogenic drug resistant trend of urinary tract infections in neonates

目的探讨新生儿尿路感染的临床特点及病原菌耐药性,指导临床合理性用药,为临床提供诊断与治疗依据。方法选取2011年3月-2013年3月成都市成华区人民医院、金牛区妇幼保健院180例新生儿尿路感染的临床资料进行分析,所有入选患儿经尿常规、中段尿细菌培养及药敏试验、相关泌尿系影像学检查,均至四川大学华西第二医院完成,分析临床表现及病原菌耐药趋势;采用SPSS17.0软件进行统计分析。结果 180例新生儿尿路感染中泌尿系畸形78例、肾发育不良13例、膀胱输尿管反流25例、输尿管囊肿27例、输尿管扩张23例、输尿管开口狭窄14例;尿路感染病原菌共检出337株,以革兰阴性菌为主208株占61.7%,居前3位的为大肠埃希菌、粪肠球菌及肺炎克雷伯菌;革兰阳性菌97株占28.8%;真菌占9.5%;大肠埃希菌对头孢西丁耐药率最低为18.7%,但肺炎克雷伯菌对头孢西丁耐药率较高,达92.3%。结论新生儿尿路感染临床上以发热为多见,革兰阴性菌为尿路感染主要的病原菌,临床分析病原菌的分布和耐药性对临床合理使用药物、尿路感染控制具有重要意义。

OBJECTIVE To explore the clinical characteristics of urinary tract infections in the neonates and patho- genic drug resistance, so as to provide guidance for clinically rational use of drugs and basis for clinical diagnosis and treatment. METHODS Clinical data of 180 neonates with urinary tract infections treated in Chengdu Chenghua People＇s Hospital and Chengdu Jinniu Maternal and Child Health Hospital from Mar 2011 to Mar 2013 were ana- lyzed, all enrolled patients through urine routine, midstream urine bacterial culture and sensitivity test, and relat- ed urological imaging studies were completed in West China Second University Hospital, then their clinical mani- festations as well as drug resistance trends of pathogens were analyzed; SPSS17.0 software was adopted for statis- tical analysis. RESULTS Among the 180 neonates with the urinary tract infections, there were 78 cases in urinary tract malformation, 13 cases in renal dysplasia, 25 cases in vesicoureteric reflux, 27 cases in ureterocele, 23 cases in ureterectasia and 14 cases in ureteral stenosis; a total of 337 strains of pathogens in the urinary tract infection were detected, among which the gram-negative bacteria accounted for 61.7% （n= 208）, and the top three were Escherichia coli, Enterococcus f aecalis, and Klebsiella pneurnoniae ; gram-positive bacteria accounted for 28.8% （n =97） ; fungi accounted for 9.5 %. The drug resistance of E. coli to cefoxitin was the lowest, with a resistance rate of 18. 7%, but the drug resistance of K. pneumoniae to cefoxitin was relatively high, up to 92. 3%. CONCLUSION Fever is the most common clinical symptom in neonates with urinary tract infections, and gram- negative bacteria is the main pathogen of the urinary tract infections, so clinical analysis of the distribution of pathogens and the drug resistance is of great significance for clinically rational use of drugs and control of the urinary tract infections.