152例小儿社区获得性尿路感染致病菌分布及耐药性分析

Bacterial pathogens and resistance patterns in community acquired pediatric urinary tract infection: experience of 152 cases

摘要:

目的：探讨小儿尿路感染致病菌分布和耐药性的变化,以指导临床用药。方法：分析从2001年12月至2004年12月期间住院治疗的尿培养结果阳性的152例尿路感染患儿的致病菌分布情况及其对抗生素的耐药性。所选病例均为社区获得性感染病例。结果：革兰阴性杆菌占79%,其中大肠杆菌占56.2%;革兰阳性球菌占18.4%,其中粪肠球菌占15.1%;另外真菌占2.6%。大肠杆菌对氨苄西林、阿莫西林/棒酸、复方新诺明、头孢拉啶、磷霉素耐药率高(>50%),而对第三代头孢菌素特别是头孢哌酮/舒巴坦的联合制剂及呋喃妥因、氨曲南、阿米卡星耐药率低,对环丙沙星耐药率为36.5%。粪肠球菌对氨苄西林、万古霉素、青霉素、呋喃妥因耐药率较低(<20%)。结论：大肠杆菌仍为小儿尿路感染主要致病菌,肠球菌有上升趋势。由于致病菌的分布及耐药性的变化,治疗前的尿培养值得临床重视。

Abstract:

OBJECTIVE: This study investigated the pathogen distribution and resistance patterns in childhood urinary tract infection in order to provide references for optimal use of antibiotics in the treatment of this disorder. METHODS: The clinical data of 152 children with community acquired urinary tract infection (urinary culture positive) between December 2001 and December 2004 were studied retrospectively. The bacterial pathogens of urinary tract infection and antimicrobial resistance were analyzed. RESULTS: Gram-negative bacilli was predominant pathogenic bacteria, accounting for 79.0% of the cases, and Escherichia coli (E.coli) was most commonly found (56.2%). Gram-positive cocci accounted for 18.4%, including 15.1% of Enterococcus faecalis. Fungi was rarely seen, accounting for only 2.6%. E.coli had a resistance rate of more than 50% to ampicillin,amoxicillin/clavulate, co-trimoxazole, cefradine, and fosomycin, but a very low resistance rate (<4%) to 3rd generation cefalosporin, nitrofurantoi, azactom and amikacin. Enterococcus faecalis had a low resistance rate (<20%) to ampicillin, vancomycin,penicillin, and nitrofurantoin. CONCLUSIONS: E.coli is the major pathogen in community acquired pediatric urinary tract infection, and Enterococcus has been become another important pathogen. Selection of antibiotics for the treatment of this disorder should base on drug-sensitive test results.