181例儿童复杂性尿路感染致病菌及耐药分析

Antibiotic resistance of pathogens isolated from 181 children with complicated urinary tract infection

摘要:

目的：探讨儿童复杂性尿路感染(complicated urinary tract infection, cUTI)的常见病原菌分布特点及耐药现状，为临床用药提供依据。方法：回顾性分析2007~2010年住院治疗的181例尿培养阳性的cUTI致病菌的分布并对常见致病菌进行的药敏试验，以观察其对抗生素的敏感性。结果：革兰阴性杆菌是cUTI的主要致病菌,占63.5%，其中大肠埃希氏菌占42.0%；革兰阳性球菌占32.1%，其中粪肠球菌占15.5%；真菌占4.4%。大肠埃希氏菌对氨苄西林耐药率最高，为89.4%，而添加了克拉维酸钾的羟氨苄西林耐药率明显降低；在头孢菌素类抗生素中，对头孢唑林、头孢曲松、头孢噻吩的耐药率均很高(>50%)，而对头孢哌酮/舒巴坦钠的耐药率明显低于其他头孢类抗生素(P<0.01)；大肠埃希氏菌对亚胺培南的耐药率为0%，对呋喃妥因的耐药率亦很低(<10%)。粪肠球菌对利福平耐药率高(78.3%),对呋喃妥因、万古霉素、利奈唑烷耐药率低(<10%)。多重耐药菌株占革兰阴性杆菌的77.4%。结论：大肠埃希氏菌是儿童cUTI的主要致病菌，但肠球菌等条件致病菌的比例相对增高，这些致病菌耐药性高且大部分呈多重耐药，故应尽量根据尿培养及药敏试验调整抗生素。

Abstract:

OBJECTIVE: To investigate the distribution and antibiotic resistance of pathogens isolated from children with complicated urinary tract infection. METHODS: A retrospective analysis was performed on the distribution and antibiotic resistance of pathogens isolated from 181 children with complicated urinary tract infection (positive urine culture). The antibiotic resistance of common pathogens was determined by the antimicrobial susceptibility test. RESULTS: Gram-negative bacilli were the main pathogens (63.5%), and involved Escherichia coli (E.coli) of 42.0%. Gram-positive cocci accounted for 32.1%, and involved enterococci faecalis of 15.5%. Fungi infection was found in 4.4% of children. The resistance rate of E.coli to ampicillin was the highest (89.4%), but the rate decreased significantly by adding amoxicillin/clavulanic acid (34.2%). E.coli had a high resistance rate to cephazolin, ceftriaxone and cafalotin (>50%), but the resistance rate of E.coli to cefoperazone/sulbouam was significantly lower than other cephalosporins (P<0.01). E.coli was sensitive to imipenem and displayed a lower resistance rate to furadantin (<10%). The resistance rate of enterococci faecalis to rifampicin was high (78.3%), but was low to furadantin, vancomycin and linezolid (<10%). The multiresistant strains accounted for 77.4% of gram-negative bacilli. CONCLUSIONS: E.coli is the major pathogen in children with complicated urinary tract infection, and the enterococci-caused urinary tract infection has been increasing. These pathogens have a high antibiotic resistance, and most of them are multiresistant. Antimicrobial therapy should be based on the results of urine culture and antimicrobial susceptibility test.