原发性肾病综合征患儿发生泌尿系感染的现状及影响因素分析

Status and influencing factors analysis of urinary tract infection in children with primary nephrotic syndrome

目的探讨原发性肾病综合征(primary nephrotic syndrome,PNS)患儿发生泌尿系感染(urinary tract infec⁃tion,UTI)的现状及影响因素。方法选取2016年1月至2023年1月首都医科大学附属北京儿童医院的住院PNS患儿49例,根据是否合并UTI分为感染组和对照组,分析两组临床表现、实验室检查结果以及治疗情况,采用多因素logistic回归方程分析PNS患儿发生UTI的影响因素。结果49例患儿中男32例,女17例;年龄10个月至14岁,平均(7.7±3.6)岁。23例(46.94%)PNS患儿发生UTI,其中19例(82.61%)患儿无发热、尿频、尿急、尿痛等症状。感染组共检出42株病原菌,其中革兰阴性杆菌18例(42.86%),以为霍氏肠杆菌、大肠埃希菌和铜绿假单胞菌为主;革兰阳性球菌17例(40.48%),以屎肠球菌及粪肠球菌为主;真菌7例(16.67%),包括白色念珠菌、光滑念珠菌和热带念珠菌。革兰阴性杆菌对氨苄西林、头孢呋辛和氨苄西林舒巴坦的耐药率均为100%,对氨基糖苷类和四环素类药物(阿米卡星、米诺环素和多黏菌素)的敏感率为100%。革兰阳性球菌对红霉素的耐药率为100%,对利奈唑胺、万古霉素、呋喃妥因的敏感率为100%。多因素logistic回归分析结果显示,糖皮质激素耐药(OR=18.185,95%CI:1.830~180.735,P=0.013)、联合免疫抑制剂治疗(OR=13.686,95%CI:1.387~135.064,P=0.025)、血清ALB<16.6 g/L(OR=10.650,95%CI:1.025~110.612,P=0.048)的PNS患儿发生UTI的风险越高,年龄越大的PNS患儿发生UTI的风险较小(OR=0.738,95%CI:0.554~0.983,P=0.038)。结论PNS患儿发生UTI时多无典型泌尿系感染症状,当其病情反复时需警惕是否发生UTI。UTI的耐药菌比例较高,真菌致病亦不容忽视。对于年龄小、激素耐药、联合免疫抑制剂治疗以及血清ALB明显下降的PNS患儿,建议加强外阴部护理,避免泌尿系感染的发生。

Objective To explore the status and influencing factors of urinary tract infection(UTI)in children with primary nephrotic syndrome(PNS).Methods A total of forty-nine children with PNS hospitalized in Beijing Children's Hospital,Capital Medical University from January 2016 to January 2023 were selected and were divided into infection group and control group according to whether they were complicated with UTI.The Clinical manifestations,laboratory results and treatment of the two groups were analyzed,and the multivariate logistic regression was used to analyze the influencing factors of UTI in children with PNS.Results Among the 49 childeren,there were 32 males and 17 females,aged from 10 months to 14 years old,and the mean age was(7.7±3.6)years.Twenty-three(46.94%)children with PNS developed UTI,of which 19(82.61%)cases had no symptoms such as fever,frequent micturition,urgency with urination or dysuria.A total of 42 strains of pathogenic bacteria were detected in the infected group,among which 18 cases were Gram-negative bacilli(42.86%),which were mainly Escherichia coli,Escherichia coli and Pseudomonas aeruginosa.Gram-positive cocci were found in 17 cases(40.48%),mainly Enterococcus faecalis and Enterococcus faecalis,and Fungi were found in seven cases(16.67%),including Candida albicans,Candida glabrata and Candida tropicalis.The resistance rate of Gram-negative bacilli to ampicillin,cefuroxime and ampicillin sulbactam was 100%,and the sensitivity rate of aminoglycosides and tetracyclines(amikacin,minocycline and polymyxin)was 100%.The resistance rate of gram-positive cocci to erythromycin was 100%,and the sensitivity rate to linezolid,vancomycin and nitrofurantoin was 100%.Multivariate logistic regression analysis results showed that UNS children with glucocorticoid resistance(OR=18.185,95%CI:1.830-180.735,P=0.013),combined immunosuppressive therapy(OR=13.686,95%CI:1.387-135.064,P=0.025),ALB<16.6 g/L(OR=10.650,95%CI:1.025-110.612,P=0.048)were more likely to have UTI,UNS children with older age(OR=0.738,95%CI:0.554-0.983,P=0.038)were more likely not to have UTI.Conclusions Children with PNS often have no typical symptoms of urinary tract infection when they have UTI,it is suggested to be alert to whether UTI occurs when the condicion is repeated.The proportion of drug-resistant bacteria in UTI is high,and fungal infection can not be ignored.For PNS children with young age,hormone resistance,treated with combined immunosuppressants and significant decrease in serum ALB,it is suggested to strengthen external genital care to avoid urinary tract infection.