儿童复杂性尿路感染致病菌及耐药分析

摘要:目的　通过对儿童复杂性尿路感染（complicated Urinary Tract Infection，cUTI）常见致病菌分布及耐药情况的研究，为临床治疗提供依据。方法　回顾性对2012年1月到2013年12月儿科住院治疗的141例尿培养阳性的cUTI致病菌的分布及常见致病菌药敏进行分析。结果　革兰阴性杆菌是导致儿童cUTI的主要致病菌，占58.6%，以大肠埃希菌（43.4%）最常见；其次革兰阳性球菌占35.2%（屎肠球菌和粪肠球菌分别占18.6%和10.3%）；真菌6.2%。大肠杆菌对氨苄西林的耐药率高达100%，添加舒巴坦后耐药率下降为52.9%；在头孢菌素类中，对头孢唑啉、头孢曲松和头孢吡肟耐药率较高（＞40%），而对头孢替坦耐药率低于其他头孢菌素类（P＜0.05），对阿米卡星、呋喃妥因和厄他培南敏感（＞95%）；屎肠球菌对青霉素，四环素等耐药率较高（＞85%），对万古霉素、替加环素和利奈唑胺敏感。结论　大肠埃希菌、屎肠球菌和粪肠球菌是尿路感染常见致病菌，这些致病菌对多种抗生素耐药率很高，应根据药敏结果调整经验用药。

Analysis of the pathogens and their drug resistance for complicated urinary tract infection in children

Abstract: Objective The study assessed the distribution and drug resistance of common pathogens for complicated urinary tract infection (cUTI) in children, aiming to provide a reference for clinical treatment of the disease. Methods The distribution and drug resistance of common pathogens detected in urine of 141 children with cUTI hospitalized at the department of pediatrics between January of 2012 and December of 2013 were retrospectively analyzed. Results The main pathogens for child cUTI were gram- negative bacteria (58.6%), especially Escherichia coli (43.4%), followed by gram-positive bacteria (35.2%), including Enterococcus faecium (18.6%) and Enterococcus faecalis (10.3%), and fungi (6.2%). Resistance rate of the E. coli to ampicillin reached 100%, but decreased to 52.9% upon addition of sulbactam. Among cephalosporins, the E. coli was most resistant against cefazolin, ceftriaxone, and cefepime (>40%) and least resistant against cefotetan (P<0.05); and the E. coli was sensitive to amikacin, macrodantin, and ertapenem (>95%). The E. faecium was highly resistant against penicillin and tetracycline (>85%), and was sensitive to vancomycin, tigecycline, and linezolid. Conclusion E. coli, E. faecium, and E. faecalis were common pathogens for urinary tract infection. As the strains are highly resistant against multiple antibiotics, empirical antibiotics treatment should be adopted according to drug sensitivity results.