97例肾病综合征合并尿路感染患儿的病原菌分布及药敏分析

Spectrum and drug sensitivity of pathogenic bacteria in children with nephrotic syndrome complicated by urinary tract infection: an analysis of 97 cases

摘要:

目的：探讨肾病综合征(NS)合并尿路感染（UTI）患儿的菌群分布及其药物敏感性特点，指导临床合理应用抗生素。方法：对2011年1~12月住院的97例NS合并UTI患儿（初发53例，复发44例）的病原菌分布特点及其药敏情况进行回顾性分析。结果：NS患儿合并UTI的发生率为36.5%，其中NS复发患儿UTI的发生率高于初发者（44.0% vs 31.9%，P<0.05），临床表现以无症状菌尿为主。病原菌分析示肠球菌比例最高（50.5%），其中屎肠球菌29.4%，粪肠球菌21.1%。其次为革兰阴性菌大肠埃希菌（15.6%）、肺炎克雷伯菌（14.7%）。肠球菌对呋喃妥因、万古霉素及利奈唑胺的敏感性较高，对四环素、莫西沙星耐药率高；屎肠球菌和粪肠球菌多重耐药菌株的检出率分别为72%和17%（P<0.05）。大肠埃希菌、肺炎克雷伯菌对丁胺卡那霉素、亚胺培南、哌拉西林/他唑巴坦敏感性较高。产超广谱β-内酰胺酶（ESBLs）革兰阴性菌的检出率为25%，产ESBLs革兰阴性菌对亚胺培南、丁胺卡那霉素及哌拉西林/他唑巴坦的敏感性为100%，对氨苄西林、头孢唑林及头孢曲松几乎无敏感性。结论：复发NS患儿较初发者更易发生UTI；肠球菌已成为NS患儿合并UTI的主要致病菌，且耐药现象严重，其中屎肠球菌多呈多重耐药。

Abstract:

OBJECTIVE: To investigate the spectrum and drug sensitivity of pathogenic bacteria in children with nephrotic syndrome (NS) complicated by urinary tract infection (UTI). METHODS: A retrospective analysis was performed on the spectrum and drug sensitivity of pathogenic bacteria in 97 children with NS complicated by UTI, who hospitalized from January to December, 2011. RESULTS: The incidence of UTI in children with NS was 36.5%. It was significantly more common in children with recurrent NS than in those with primary NS (44.0% vs 31.9%; P<0.05). These cases mainly presented with asymptomatic bacteriuria. Enterococcus was the most common pathogenic bacteria (50.5%), including Enterococcus faecium (29.4%) and Enterococcus faecalis (21.1%), followed by Gram-negative bacteria, such as Escherichia coli (15.6%) and Klebsiella pneumoniae (14.7%). Enterococcus was highly sensitive to nitrofurantoin, vacomycin and linezolid, but was highly resistant to tetracycline and moxifloxacin. More multi-resistant strains were detected in Enterococcus faecium than in Enterococcus faecalis (72% vs 17%; P<0.05). Escherichia coli and Klebsiella pneumoniae were highly sensitive to amikacin, imipenem and piperacillin/tazobactam. Of the Gram-negative bacteria, 25% produced extended spectrum β-lactamases (ESBLs). ESBLs-producing bacteria had 100% sensitivity to imipenem, amikacin and piperacillin/tazobactam but were highly resistant to ampicillin, cefazolin and ceftriaxone. CONCLUSIONS: Children with recurrent NS are more susceptible to UTI than those with primary NS. Enterococcus is becoming major pathogenic bacteria for UTI in children with NS and has relatively high drug resistance, and most strains of Enterococcus faecium are multi-resistant.