学龄期儿童尿路感染的致病菌和药物敏感性研究

Pathogenic bacteria and drug susceptibility of urinary tract infection in school-age children

目的探讨学龄期儿童尿路感染(UTI)的致病菌和药物敏感性。方法回顾性分析2019年1月至2021年12月武穴市第一人民医院收治的78例学龄期UTI患儿的临床资料。分析不同类型UTI患儿中段尿中致病菌分布情况,主要革兰阴性菌/革兰阳性菌对常用抗生素的药物耐药性及敏感性。结果不同类型UTI患儿中段尿中致病菌均以革兰阴性菌为主,构成比均>70%。78例UTI患儿共检出84株致病菌,致病菌以革兰阴性菌(73.81%)为主,主要为大肠埃希菌(47.63%)、肺炎克雷伯菌(9.52%);革兰阳性菌中以屎肠球菌(13.10%)、粪肠球菌(4.76%)为主。大肠埃希菌对头孢克洛、头孢呋辛、氨苄西林、美洛西林耐药率均>70.00%;大肠埃希菌对头孢替坦、头孢哌酮舒巴坦、哌拉西林他唑巴坦、阿莫西林克拉维酸钾、亚胺培南、美洛培南、厄他培南100.00%敏感,对头孢他啶、头孢吡肟、呋喃妥因、阿米卡星敏感性较高,敏感率均≥70.00%;肺炎克雷伯菌对头孢唑林耐药率较高(75.00%),对头孢克洛、头孢呋辛、氨苄西林、美洛西林、头孢哌酮舒巴坦、阿莫西林克拉维酸钾均100.00%耐药;肺炎克雷伯菌对头孢替坦、阿米卡星100.00%敏感,对头孢吡肟、哌拉西林他唑巴坦、阿莫西林克拉维酸钾、亚胺培南、美洛培南、厄他培南、环丙沙星敏感性较高,敏感率均为87.50%。屎肠球菌对青霉素、阿莫西林、阿莫西林克拉维甲酸、氨苄西林耐药率均>70.00%,对红霉素、环丙沙星、克林霉素均100.00%耐药;粪肠球菌对红霉素耐药率较高(75.00%),对克林霉素100.00%耐药。结论UTI患儿中段尿中致病菌以革兰阴性菌为主,革兰阴性菌对头孢克洛、头孢呋辛、氨苄西林、美洛西林的耐药率较高,革兰阳性菌对红霉素、克林霉素的耐药率较高,临床中应依据药敏试验结果合理选用抗生素。

Objective To explore the pathogenic bacteria and drug susceptibility of urinary tract infection(UTI)in school-aged children.Methods The clinical data of 78 school-age children with UTI admitted to the First People's Hospital of Wuxue City from January 2019 to December 2021 were retrospectively analyzed,the distribution of pathogenic bacteria in the middle urine of children with different types of UTI was analyzed,and the drug resistance and sensitivity of the main Gram-negative/Gram-positive bacteria to commonly used antibiotics were analyzed.Results The pathogenic bacteria in the middle urine of children with different types of UTI were mainly Gram-negative bacteria,and the proportion was>70.00%.Among 78 children with UTI,84 pathogenic bacteria were detected,the main pathogenic bacteria were Gram-negative bacteria(73.81%),and the pathogenic bacteria were mainly Escherichia coli(47.63%),Klebsiella pneumoniae(9.52%);the main Gram-positive bacteria were Enterococcus faecium(13.10%),Enterococcus faecalis(4.76%).The drug resistance rates of Escherichia coli to cefaclor,cefuroxime,ampicillin and melocillin were all>70.00%;Escherichea coli was 100.00%sensitive to cefotetan,cefoperazone sulbactam,piperacillin tazobactam,amoxicillin clavulanate potassium,imipenem,meropenem and ertapenem,the sensitivity to ceftazidime,cefepime,furantoin and amikacin was higher,and the sensitivity rate was≥70.00%;the drug resistance rates of Klebsiella pneumoniae to cefazolin was higher(75.00%),and it was 100.00%resistant to cefaclor,cefuroxime,ampicillin,melocillin,cefoperazone sulbactam and amoxicillin clavulanate potassium;Klebsiella pneumoniae was 100.00%sensitive to cefotetan and amikacin,the sensitivities to cefepime,piperacillin tazobactam,amoxicillin clavulanate potassium,imipenem,meropenem,ertapenem and ciprofloxacin were 87.50%.The drug resistance rates of Enterococcus faecium to penicillin,amoxicillin,amoxicillin clavitretinoin,ampicillin were all>70.00%,and the drug resistance to erythromycin,ciprofloxacin and clindamycin were all 100.00%;the drug resistance rates of Enterococcus faecalis to erythromycin was higher(75.00%),and it was 100.00%resistant to clindamycin.Conclusion The pathogenic bacteria in the middle urine of children with UTI are mainly Gram-negative bacteria,the drug resistance rate of Gram-negative bacteria to cefaclor,cefuroxime,ampicillin and meloxicillin was higher,while the resistance rate of Gram-positive bacteria to erythromycin and clindamycin was higher,and antibiotics should be reasonably selected according to the results of drug susceptibility test in clinical practice.