284例儿童泌尿道感染的临床特点及病原学分析

The clinical characteristics and etiology analysis of 284 children with urinary tract infection

目的探讨儿童泌尿道感染的临床特点、常见病原菌分布及耐药情况。方法回顾性收集284例泌尿道感染患儿的临床资料、尿液细菌培养结果及药敏试验,并进行统计学分析结果泌尿道感染患儿最常见的合并症状为呼吸道症状,其次为消化道症状。138例检出病原菌,检出率为48.59%。革兰氏阴性菌118例(88.24%),以大肠埃希菌为主共94例(78.33%),其中产ESBLs49例(52.13%)。革兰氏阳性菌以粪肠球菌为主共6例(37.50%)。大肠埃希菌对旅拉西拉、氨苄西林、复方新诺明的耐药率较高,其中哌拉西拉和氨苄西林的耐药率均在70%以上,而对亚胺培南、美罗培南、呋喃妥因、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、阿米卡星的耐药率均低于10%。屎肠球菌对氨苄西林、克林霉素、红霉素的耐药率均在60%以上,对万古霉素、利奈唑胺及呋喃妥因耐药率低。结论泌尿道感染患儿临床上常以发热等呼吸道感染症状首诊,尤其是婴幼儿。大肠埃希菌为常见致病菌,但肠球菌的检出率近年来有所增加。

Objective To investigate the clinical characteristics,common pathogenic bacteria distribution and drug resistance of urinary tract infection in children in Jiaxing area.Methods Clinical data,urine bacterial culture results and drug sensitivity test of 284 children with urinary tract infection were retrospectively collected and statistically analyzed.Results The most common complications in children with urinary tract infection were respiratory symptoms,followed by digestive symptoms.138 cases were detected,and the detection rate was 48.59%.118 cases(88.24%)were gram-negative bacteria,94 cases(78.33%)were Escherichia coli,among which 49 cases(52.13%)were ESBLs-producing bacteria.Enterococcus faecalis was the main gram-positive bacteria in 6 cases(37.50%).The drug resistance rates of Escherichia coli to piperacillin,ampicillin and cotrimoxazole were high,among which the drug resistance rates of piperacillin and ampicillin were all above 70%,while the drug resistance rates of imipenem,meropenem,nitrofurantoin,piperacillin/tazobactam,cefoperazone/sulbactam and amikacin were all less than 10%.The drug resistance rate of Enterococcus faecium to ampicillin,clindamycin and erythromycin was more than 60%,and the drug resistance rate to vancomycin,linezolid and nitrofurantoin was low.Conclusion Children with urinary tract infection in Jiaxing area are often first diagnosed with respiratory tract infection symptoms such as fever,especially infants.Escherichia coli is a common pathogen,but the detection rate of enterococcus has increased in recent years.