非复杂性和复杂性婴儿泌尿系感染的临床特点及病原分析

Clinical features and pathogens analysis of complicated and non - complicated urinary tract infections in infants

目的总结婴儿泌尿系感染（UTI）的临床及病原特点，为临床诊治提供参考依据。方法收集中国医科大学附属盛京医院小儿肾脏风湿免疫科2012年1月至2015年1月符合UTI诊断标准的住院婴儿188例，根据影像学结果将其分为复杂组（复杂性UTI）和非复杂组（非复杂性UTI），分析2组一般情况、临床表现、血清学检查、尿培养、病原菌分布及药敏结果上的差异。结果188例UTI婴儿中，男148例，女40例；复杂组50例（26.6%），非复杂组138例（73.4%）。复杂组患儿母孕期超声异常的比例（34.0%）、反复感染的发生率（24.0%）、发热的发生率（78.0%）、外周血WBC计数[（16.4±4.3）×10^9/L]均高于非复杂组[1.5%，10.9%，58.7%，（14.6±3.5）×10^9/L]（P均〈0.05），而肉眼血尿的发生率低于非复杂组（14.0%比34.8%，P＝0.006）。复杂组患儿肺炎克雷伯菌阳性率高于非复杂组（22.0%比2.9%，P＝0.000），而大肠埃希菌阳性率低于非复杂组（26.0%比46.4%，P＝0.000），2组尿培养病原菌对各种药物的敏感性及耐药性无差异。结论对于发热、外周血WBC升高、反复感染和尿培养为肺炎克雷伯菌的UTI婴儿，尤其应警惕泌尿系畸形的存在，及时完善泌尿系超声及尿路造影十分必要。

Objective To summarize the clinical and pathogenic characteristics of urinary tract infection（UTI） in infants, and to provide reference for clinical diagnosis and treatment.Methods One hundred and eighty-eight cases of hospitalized infants with UTI diagnosis standard in Department of Pediatric Renal Rheumatism Immunology, Shengjing Hospital Affiliated to China Medical University from January 2012 to January 2015 were collected, and on the basis of the imaging they were divided into complex group（complicated UTIs） and non-complex group（non-complicated UTIs）, the differences between 2 groups in the general condition, clinical manifestations, serological examination, urine culture and distribution of pathogenic bacteria and drug sensitivity Results were analyzed.Results Among 188 UTI infants, 148 were male and 40 were female, 50 cases were in complex group（26.6%）, and 138 cases were in non-complex group（73.4%）. In complex group, the prevalence of prenatal ultrasound abnormalities（34.0%）, the incidence of recurrent infections（24.0%）, the number of fever incidence（78.0%）, and peripheral WBC count[（16.4±4.3）×10^9/L] were higher than those in non-complex group[1.5%, 10.9%, 58.7%, （14.6±3.5）×10^9/L]（all P〈0.05）, and the naked eye hematuria incidence was lower than that of the non-complex group（14.0% vs 34.8%, P=0.006）. In complex group, pneumonia klebsiella bacteria positive rate was higher than that of non-complex group（22.0% vs 2.9%, P=0.000）, and the positive rate of Escherichia coli was lower than that of non-complex group（26.0% vs 46.4%, P=0.000）. There was no difference in the drug sensitivity and resistance of the pathogenic bacteria in the urine culture of 2 groups.Conclusions For fever, increased peripheral WBC, repeated infection and urine culture for Klebsiella pneumoniae UTI infants, in particular, should be alert to the prese-nce of urinary tract abnormalities, timely improve the urinary system ultrasound and urinary tract contrast is very necessary.