儿童泌尿系感染病原菌的分布及耐药性

Distribution and drug resistance of pathogenic bacteria in children with urinary tract infection

目的探讨儿童泌尿系感染常见病原菌的分布及耐药,为临床合理选用抗生素提供参考。方法 2015年1月-2016年12月本院泌尿系感染患儿中段尿标本,男363例,女284例,年龄5 d^6岁,回顾性分析分离病原菌的分布及药敏结果。结果检出病原菌647株,检出的前6位病原菌依次为大肠埃希菌(31.4%)、屎肠球菌(15.6%)、粪肠球菌(13.6%)、肺炎克雷伯菌(11.0%)、铜绿假单胞菌(7.6%)、真菌(3.6%)。大肠埃希菌对氨苄西林耐药性高达77.3%,对头孢唑啉、头孢曲松的耐药率分别为69.0%、57.6%,未发现亚胺培南耐药的菌株,超广谱β-内酰胺酶(ESBLs)产生率65%。肺炎克雷伯菌对氨苄西林呈现100%耐药,对头孢唑啉、头孢曲松的耐药率分别为88.7%、54.9%,对亚胺培南的耐药率在2.8%,ESBLs产生率53.5%。革兰阳性球菌对氟喹诺酮类的耐药率较低,未发现万古霉素菌株。结论大肠埃希菌为儿童泌尿系感染的主要病原菌,对常用抗生素耐药情况严重;根据药敏结果合理应用抗生素是有效控制儿童泌尿系感染和减少耐药菌株产生的重要手段。

Objective To investigate the distribution and drug resistance of common pathogens of urinary tract infection in children and provide references for the rational use of antimicrobial agents in clinic. Methods The distribution and drug susceptibility results of pathogenic bacteria isolated from urinary samples of urinary tract infections from January 2015 to December 2016 in our hospital were retrospectively analyzed. 363 cases of male,284 cases of female,age 5 d^6 years.Results A total of 647 pathogens were detected. The top 6 pathogens detected were Escherichia coli（31.4%）,Enterococcus faecium（15.6%）,Enterococcus faecali（13.6%）,Klebsiella pneumoniae（11.0 %）,Pseudomonas（7.6%）and Fungi（3.6%）. The resistance of Escherichia coli to ampicillin was as high as 77.3%. The resistance rates to cefazolin and ceftriaxone were 69.0% and 57.6%,respectively. No strains resistant to imipenem were found. The incidence of extended spectrum Betalactamases（ESBLs）was 65%. Klebsiella pneumoniae showed 100% resistance to ampicillin,and the resistance rates to cefazolin and ceftriaxone were 88.7% and 54.9%,respectively. The resistance rate to imipenem was 2.8% and the incidence of ESBLs was 53.5%. Gram positive bacteria fluoroquinolones resistance rate was low;no vancomycin strains were found.Conclusion Escherichia coli was the main pathogen of urinary tract infection in children and has serious resistance to commonly used antibiotics. The rational use of antibacterials according to the drug susceptibility results is an important means to effectively control the urinary tract infection in children and reduce the generation of resistant strains.