儿童复杂性上尿路感染68例临床特点

Clinical features of 68 cases of complicated upper urinary tract infection in children

目的探讨儿童复杂性上尿路感染的临床特点，为临床诊治提供依据。方法收集2013年1月至2015年8月深圳市儿童医院泌尿外一科收治的复杂性上尿路感染患儿的临床资料，进行回顾性分析。结果共68例，男44例，女24例；其中反复感染15例。临床表现以发热（48例，70．59％）最常见，尿频、尿痛（9例，13．24％）较少见。68例患儿均行尿培养，培养出57例菌株，其中3例患儿分别培养出2种不同菌株。革兰阴性菌41株，革兰阳性菌15株，真菌1株。大肠埃希菌14株，检出超广谱β-内酰胺酶（ESBLs）阳性11株；肺炎克雷伯菌11株，检出ESBLs阳性8株。革兰阴性菌对氨苄西林、头孢呋辛钠等耐药率均〉90％，对哌拉西林／他唑巴坦等敏感率〉90％。经哌拉西林／他唑巴坦抗感染治愈31例，另外经头孢呋辛钠治疗无缓解改用哌拉西林／他唑巴坦抗感染治愈15例。结论复杂性上尿路感染患儿的临床表现不典型，以发热为主，尿路感染易反复。病原学以革兰阴性杆菌为主；ESBLs阳性菌株比例较高；青霉素、第一、二代头孢耐药率高；哌拉西林／他唑巴坦对细菌敏感性高、抗感染效果佳。

Objective To study the clinical features of complicated upper urinary tract infection in children, aiming to provide a reference for clinical diagnosis and treatment of the disease. Methods The clinical data of 68 cases with complicated upper urinary tract infection hospitalized at the Department of Urinary Surgery NO. 1, Children＇s Hospital of Shenzhen between January 2013 and August 2015 were retrospectively analyzed. Results A total of 68 cases, in which 44 were male, 24 were female, and repeated infections were found in 15 cases. Fever was the most common clinical manifestation（48 cases,70.59% ） ,while frequent urination and odynuria were rare（9 cases,15.24% ）. A total of 57 strains had been cultured form the submitted specimens which were obtained from the 68 cases, including 41 strains of gram -negative bacteria, 15 strains of gram - positive bacteria and 1 strain of fungus. Two different strains were cultured in 3 children. Fourteen strains of Escherichia coli had 11 extended spectrum beta lactamases （ESBLs） - positive strains. In the 11 strains of klebsiella pneumoniae, 8 trains were ESBLs - positive. The drug resistant rates of gramnegative bacteria to Ampicillin and Cefuroxime sodium were both more than 90%. The sensitive rates to Piperacillin/Tazobactam was more than 90%. Thirty - one cases of complicated upper urinary tract infection were cured by administering Piperacillin/Tazobactam, while 15 cases were cured by changing Cefuroxime sodium to Piperacillin/ Tazobactam according to the drug sensitivity results. Conclusions Clinical manifestations of complicated upper urinary tract infection are untypical, and fever is the most common symptom. Repeated infection is common. The gram - negative bacteria is the dominant pathogen causing the complicated upper urinary tract infection. ESBLs - positive bacteria accounts for high proportion. The drug resistance rate to penicillin and the first, second generation of the cephalosporin is high. The drug sensitive rate of piperacillin tazobactam is high, with good prognosis.