小儿尿路感染病原菌分布及耐药性分析

The analysis of microflora distribution and drug resistance of urinary tract infection in children

目的探讨小儿尿路感染的常见病原菌并分析其耐药情况。方法回顾性分析2018年1月至12月我院收治的108例尿培养阳性的尿路感染患儿的临床资料,分析其病原菌及抗菌药物耐药情况,并将患儿分为单纯尿路感染组(29例)和复杂尿路感染组(79例),对比两组革兰阴性菌耐药情况。结果共检出116株细菌,其中革兰阴性菌90株(77.59%),革兰阳性菌26株(22.41%)。其中大肠埃希菌、肺炎克雷伯菌、屎肠球菌为主要病原菌。革兰阴性菌对阿米卡星、亚胺培南、哌拉西林/他唑巴坦耐药率最低,在10%左右;对呋喃妥因、喹诺酮类药物耐药率在20%左右;对三、四代头孢菌素及其含酶抑制剂耐药率在30%~40%;未发现对万古霉素、利奈唑胺耐药的革兰阳性菌。革兰阳性菌对链霉素、呋喃妥因耐药率在0~20%。单纯尿路感染组与复杂尿路感染组中的革兰阴性菌对常见抗生素耐药率比较差异无统计学意义(P>0.05)。结论革兰阴性菌是尿路感染的主要病原菌,随着耐药情况的改变,可能需要改变经验性抗感染药物,呋喃妥因可以作为轻症患儿经验性应用的推荐,既往可能低估了单纯尿路感染病原耐药情况,需进一步研究。

Objective To investigate the distribution and drug resistance of pathogens in urinary tract infection in children.Methods The clinical data of 108 cases of urinary tract infections with positive urinary culture from January 2018 to December 2018 in our hospital were analyzed retrospectively.The patients were divided into simple urinary tract infection group(n=29)and complex urinary tract infection group(n=79).Antibiotic resistance in each group was compared.Results Gram-negative bacilli were found in 90 cases(77.59%,90/116).Gram-positive cocci were found in 26 cases(22.41%,26/116).Escherichia coli,Klebsiella pneumoniae and Enterococcus faecium were the main pathogens.Gram-negative bacilli had the lowest resistance rate to amikacin,imipenem and piperacillin/tazobactam(about 10%).The resistance rate of Gram-negative bacilli to furantoin and quinolones was about 20%,while 30%to 40%to the third and fourth generation cephalosporins and their enzymatic preparations.No Gram-positive cocci was found to be resistant to vancomycin and linezolid.The resistance rate of Gram-positive bacteria to streptomycin and furantoin was 0-20%.There was no significant difference in resistance rate of Gram-negative bacteria to common antibiotics between simple urinary tract infection group and complex urinary tract infection group(P>0.05).Conclusion Gram-negative bacteria are the main pathogens of urinary tract infections.With the change of drug resistance of pathogens,it may be necessary to change the empirical treatment of urinary tract infection.Furantor can be used as a recommendation for the empirical treatment of mild infection.In the past,there may be underestimate of drug resistance of simple urinary tract infection,and further research is needed.