抗菌药物在儿童原发性肾病综合征合并尿路感染治疗中的合理运用策略探究

Research on the rational use of antibiotics in children with primary nephrotic syndrome with urinary tract infection

目的 探究儿童原发性肾病综合征合并尿路感染的病原学情况,并分析不同抗菌药物对其的合理运用策略。方法 120例儿童原发性肾病综合征患儿,所有患儿按照是否合并尿路感染分为合并尿路感染组和无尿路感染组,每组60例。分析两组的一般资料和相关指标检测水平及相应的易感因素,包括24 h尿蛋白定量、胆固醇、免疫球蛋白G(IgG)、血肌酐(Scr)、白蛋白(Alb)等。对儿童原发性肾病综合征合并尿路感染组患儿采集清洁中段尿送检,实施病原学检查,统计患儿细菌分离情况、大肠杆菌药敏试验情况。结果 合并尿路感染组患儿24 h尿蛋白定量(4.09±1.25)mg/(m^(2)·h)、Scr(135.12±15.02)μmol/L均高于无尿路感染组的(2.51±0.13)mg/(m^(2)·h)、(99.15±10.35)μmol/L,IgG(3.15±0.25)g/L、Alb(20.33±2.02)g/L均低于无尿路感染组的(5.56±0.31)、(26.35±1.05)g/L,差异均具有统计学意义(P<0.05)。60例患儿经细菌分离一共获得62株细菌,其中50株(80.65%)为革兰阴性菌,12株(19.35%)为革兰阳性菌。30株大肠杆菌对亚胺培南的敏感率最高,为96.67%(29/30),其次为氧哌嗪青霉素、他唑巴坦,敏感率均为86.67%(26/30),对阿莫西林、克拉维酸的敏感率均为80.00%(24/30),对头孢曲松敏感率为76.67%(23/30),对阿米卡星的敏感率为66.67%(20/30),对头孢噻肟的敏感率为60.00%(18/30),对头孢呋辛的敏感率为46.67%(14/30),对复方新诺明的敏感率为46.67(14/30),对庆大霉素的敏感率为40.00%(12/30),对环丙沙星的敏感率为26.67%(8/30),对哌拉西林的敏感率为10.00%(3/30),对氨苄西林的敏感率为6.67%(2/30)。结论 儿童原发性肾病综合征合并尿路感染存在一定的易感因素,临床治疗中应对相关易感因素予以早期干预,并对患儿实施一定的预见性抗菌药物,之后结合药敏试验和患儿的临床表现选择敏感抗菌药物进行治疗,合理调整治疗方案,以获得更好的临床效果。

Objective To investigate the etiology of children with primary nephrotic syndrome with urinary tract infection,and analyze the rational use of different antibiotics.Methods A total of 120 children with primary nephrotic syndrome were included.All the children were divided into urinary tract infection group and no urinary tract infection group according to whether they were combined with urinary tract infection,with 60 cases in each group.The general data,detection levels of related indicators and the corresponding susceptibility factors,including 24-h urinary protein quantification,cholesterol,immunoglobulin G(IgG),serum creatinine(Scr),albumin(Alb),of the two groups were analyzed.For children in urinary tract infection group,clean mid-stage urine was collected and sent for examination,and pathogenic examination was performed to count the bacterial isolation and Escherichia coli drug sensitivity test of the children.Results The 24-h urinary protein quantification(4.09±1.25)mg/(m^(2)·h)and Scr(135.12±15.02)μmol/L in urinary tract infection group were higher than(2.51±0.13)mg/(m^(2)·h),(99.15±10.35)μmol/L in the no urinary tract infection group;the IgG(3.15±0.25)g/L and Alb(20.33±2.02)g/L were lower than(5.56±0.31)and(26.35±1.05)g/L in no urinary tract infection group;all the differences were statistically significant(P<0.05).A total of 62 bacterial strains were obtained by bacterial isolation from 60 children,of which 50 strains(80.65%)were Gram-negative and 12 strains(19.35%)were Gram-positive.30 strains of E.coli had the highest susceptibility to imipenem at 96.67%(29/30),followed by oxypiperazine penicillin and tazobactam,both at 86.67%(26/30),and amoxicillin and clavulanic acid at 80.00%(24/30),ceftriaxone at 76.67%(23/30),amikacin at 66.67%(20/30),cefotaxime at 60.00%(18/30),cefuroxime at 46.67%(14/30),compound sulfamethoxazole at 46.67(14/30),gentamicin at 40.00%(12/30),ciprofloxacin at 26.67%(8/30),piperacillin at 10.00%(3/30),and ampicillin at 6.67%(2/30).Conclusion There are certain susceptibility factors for primary nephrotic syndrome with urinary tract infection in children,and the relevant susceptibility factors should be intervened early in clinical treatment,and certain anticipatory antibiotics should be administered to the children,after which sensitive antibacterial drugs should be selected for treatment in combination with drug sensitivity tests and clinical manifestations of the children,and the treatment plan should be reasonably adjusted to obtain better clinical results.