摘要： 目的 探讨儿童单发尿路感染与再发性尿路感染的病原菌分布及耐药性，为合理使用抗生素提供依据。方法 回顾性分析2015年1月1日至2019年12月31日我科单发和再发性尿路感染住院患儿的临床资料，包括性别、年龄、尿培养结果、耐药情况及抗生素使用情况。结果 本研究共纳入尿路感染患儿777例，共987份病原学标本（单发组681份，再发组306份）。2组患者性别、年龄无统计学差异（P=0.180，P=0.055）。再发组泌尿系统畸形发生率（77.1%）显著高于单发组（20.1%），差异有统计学意义（P=0.001）。2组共检出515株病原菌（阳性检出率52.1%），其中86.4%为革兰氏阴性菌，12.0%为革兰氏阳性菌，1.5%为真菌。单发组与再发组最常见病原菌均为大肠埃希菌（70.1% vs 38.9%）。再发组非大肠埃希菌比例（61.1%）高于单发组（29.9%），差异有统计学意义（P=0.001）。药敏试验结果显示，2组大肠埃希菌、肺炎克雷伯杆菌对碳青霉烯类、β-内酰胺酶抑制剂复合制剂及磷霉素耐药性低。屎肠球菌、粪肠球菌对万古霉素、利奈唑胺、替加环素耐药性较低。多数抗菌药再发组耐药性高于单发组。临床经验性用药中，最常用的是头孢曲松钠/他唑巴坦钠。结论 尿路感染住院患儿尿培养以大肠埃希菌为主，再发性尿路感染患儿非大肠埃希菌比例显著增高，且耐药性多于单发尿路感染。及时监测病原菌种类及药物耐药性分析，有助于选择合适抗生素控制尿路感染。

儿童单发与再发性尿路感染病原菌分布及耐药性分析

尹璐, 杜悦

中国医科大学附属盛京医院小儿肾脏风湿免疫科, 沈阳 110004

收稿日期:2023-01-19出版日期:2023-09-30发布日期:2023-09-02
通讯作者:杜悦E-mail:duy@sj-hospital.org
作者简介:尹璐(1988-),女,主治医师,硕士.



关键词: 尿路感染, 儿童, 病原, 耐药
Abstract: Objective To investigate bacterial pathogens and antibiotic resistance patterns in single and recurrent pediatric urinary tract infection to provide a basis for the rational use of antibiotics. Methods The clinical data of 777 hospitalized patients with single and recurrent urinary tract infection in a pediatric nephrology department from January 2015 to December 2019 were retrospectively analyzed, including sex, age, urine culture results, drug resistance, and antibiotic use. Results A total of 987 etiological samples were collected from 777 children with urinary tract infection (681 in the single group and 306 in the recurrent group). No significant difference was found in sex or age between the two groups (P=0.180 and 0.055, respectively). The incidence of urinary malformation in the recurrent group (77.1%) was significantly higher than that in the single group (20.1%), and the difference was statistically significant (P=0.001). A total of 515 strains of pathogenic bacteria (positive rate of 52.1%) were detected, of which 86.3% were Gram-negative bacteria, 11.9% were Gram-positive bacteria, and 1.5% were fungi. The most common pathogen in both the single and recurrent groups was Escherichia coli (70.1% vs. 38.9%). The rate of non-Escherichia coli in the recurrent group (61.1%) was significantly higher than that in the single group (29.9%). The results of the drug sensitivity test showed that infections with Escherichia coli and Klebsiella pneumoniae in both the single and recurrent groups had low resistance to carbapenem, β-lactamase inhibitor, and fosfomycin. Enterococcus faecium, and Enterococcus faecalis were less resistant to vancomycin, linezolid, and tegacycline. The drug resistance of most of the antimicrobial agents in the recurrent group was higher than that in the single group. Among the clinical empirical drugs, ceftriaxone sodium and tazobactam sodium were the most commonly used. Conclusion Escherichia coli is the main uropathogen in hospitalized children with urinary tract infection, the proportion of non-Escherichia coli in children with recurrent urinary tract infection is significantly higher, and drug resistance is higher in the recurrent group than that in the single group. Timely monitoring of the types of pathogens and analysis of drug resistance would help with the selection of suitable antibiotics to control urinary tract infection.
Key words: urinary tract infection, children, pathogen, antibiotic resistance
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