泌尿系统先天畸形致复发性尿路感染病原菌分布及耐药性分析
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摘要
目的探讨泌尿系统先天畸形导致的复发性尿路感染病原菌分布及耐药性特点,为临床合理选用抗菌药物提供依据。方法收集2013年8月至2017年8月深圳市儿童医院收治的伴有泌尿系统先天畸形的复发性尿路感染患儿尿液标本,用VITEK 2COMPACT型全自动细菌培养鉴定仪及其配套的革兰阴性菌、革兰阳性菌鉴定卡、药敏卡进行菌种鉴定及药敏试验。结果 121例患儿初发感染病原菌142株,复发感染病原菌203株,其中39例(32.23%)42株(20.69%)复发感染菌株与初发感染菌株相同。初发组与复发组大肠埃希菌与肺炎克雷伯菌产超广谱β-内酰胺酶(ESBLs)菌株阳性率差异无统计学意义(P>0.05)。革兰阴性菌占伴泌尿系统先天畸形尿路感染病原菌首位(53.62%),其次为肠球菌属(19.71%);复发感染组屎肠球菌发病率下降,真菌发病率升高,与初发组比较,差异有统计学意义(P<0.05)。初发组及复发组主要革兰阴性菌及革兰阳性菌对所有抗菌药物耐药率差异均无统计学意义(P>0.05)。结论伴泌尿系统先天畸形尿路感染复发患儿较初发患儿相比,病原菌分布有改变,经验用药时不能完全根据初次感染病原菌用药。
Objective To investigate the distribution and drug resistance characteristics of recurrent urinary tract infection caused by congenital malformations of urinary system,and to provide evidence for rational use of antibiotics in clinic.Methods Data of recurrent urinary tract infections with congenital malformations of the urinary system in our hospital from August 2013 to August 2017 were collected.Strain identification and drug sensitivity test were analyzed by VITEK 2 COMPACT analyzer.Results There were 142 strains of pathogenic bacteria in 121 cases of children with primary infection and 203 strains of pathogenic bacteria in recurrent infection.Among them,39 cases(32.23%)with 42 strains(20.69%)of recurrent infection were the same as those in primary infection.ESBLs production by Escherichia coli and Klebsiella pneumoniae was not significantly different between the initial and recurrent groups(P>0.05).Gram-negative bacteria accounted for 53.62% of the pathogenic bacteria in urinary tract infection with congenital malformation of urinary system,followed by Enterococcus(19.71%).The incidence of Enterococcus fascism decreased and the incidence of fungi increased in the recurrent infection group(P<0.05).There was no significant difference in the resistance rates of all antimicrobial agents between primary and recurrent Gram-negative bacteria and Gram-positive bacteria(P>0.05).Conclusion The distribution of pathogenic bacteria in the recurrence group of urinary tract infection with congenital malformation of urinary system is different from that in the initial group.The experiential use of antibiotics could not depend entirely on the pathogenic bacteria of the first infection.
Objective To investigate the distribution and drug resistance characteristics of recurrent urinary tract infection caused by congenital malformations of urinary system,and to provide evidence for rational use of antibiotics in clinic.Methods Data of recurrent urinary tract infections with congenital malformations of the urinary system in our hospital from August 2013 to August 2017 were collected.Strain identification and drug sensitivity test were analyzed by VITEK 2 COMPACT analyzer.Results There were 142 strains of pathogenic bacteria in 121 cases of children with primary infection and 203 strains of pathogenic bacteria in recurrent infection.Among them,39 cases(32.23%)with 42 strains(20.69%)of recurrent infection were the same as those in primary infection.ESBLs production by Escherichia coli and Klebsiella pneumoniae was not significantly different between the initial and recurrent groups(P>0.05).Gram-negative bacteria accounted for 53.62% of the pathogenic bacteria in urinary tract infection with congenital malformation of urinary system,followed by Enterococcus(19.71%).The incidence of Enterococcus fascism decreased and the incidence of fungi increased in the recurrent infection group(P<0.05).There was no significant difference in the resistance rates of all antimicrobial agents between primary and recurrent Gram-negative bacteria and Gram-positive bacteria(P>0.05).Conclusion The distribution of pathogenic bacteria in the recurrence group of urinary tract infection with congenital malformation of urinary system is different from that in the initial group.The experiential use of antibiotics could not depend entirely on the pathogenic bacteria of the first infection.
引文
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[12]中华医学会儿科学分会肾脏学组.泌尿道感染诊治循证指南(2016)[J].中华儿科杂志,2017,55(12):902-904.
[13]SAVAR N S,JAHANIAN-NAJAFABADI A,MAHDA-VI M,et al.In silico and in vivo studies of truncated forms of flagellin(FliC)of enteroaggregative Escherichia coli fused to FimH from uropathogenic Escherichia coli as a vaccine candidate against urinary tract infections[J].JBiotechnol,2014,175(8):31-37.
[2]MISHRA O P,ABHINAY A,PRASAD R.Urinary infections in children[J].Indian J Pediatr,2013,80(10):838-843.
[3]BERGMAN D A,BALTZ R D,COOLEY J R.Subcommittee on Urinary Tract Infections.Practice parameter:the diagnosis,treatment,and evaluation of the initial UTIin febrile infants and young children[J].Pediatrics,1999,103(4):843-852.
[4]Subcommittee on Urinary Tract Infection,Steering Committee on Quality Improvement and Management,RO-BERTS K B.Urinary tract infection:clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2to 24months[J].Pediatrics,2011,128(3):595-610.
[5]STEIN R,DOGAN H S,HOEBEKE P,et al.Urinary tract infections in children:EAU/ESPU guidelines[J].Euro Urol,2015,67(3):546-558.
[6]GOLAN Y.Empiric therapy for hospital-acquired,Gramnegative complicated intra-abdominal infection and complicated urinary tract infections:a systematic literature review of current and emerging treatment options[J].BMCInfect Dis,2015,15(1):1-7.
[7]KASHANIAN J,HAKIMIAN P,JR B M,et al.Nitrofurantoin:the return of an old friend in the wake of growing resistance[J].BJU Int,2010,102(11):1634-1637.
[8]VELEZ E C,SERNAHIGUITA L M,SERRANO A K,et al.Resistance profile for pathogens causing urinary tract infection in a pediatric population,and antibiotic treatment response at a university hospital,2010-2011[J].Colomb Med(Cali),2014,45(1):39-44.
[9]HOBERMAN A,GREENFIELD S P,MATTOO T K,et al.Antimicrobial prophylaxis for children with vesicoureteral reflux[J].Indian Pediatr,2014,51(7):571-574.
[10]高香玲,于茂莲.复发性尿路感染细菌检验与药敏情况探究[J].中国伤残医学,2016,24(9):187-188.
[11]曹辉秀.复发性尿路感染的细菌检验、药敏情况及用药分析[J].深圳中西医结合杂志,2016,26(20):28-29.
[12]中华医学会儿科学分会肾脏学组.泌尿道感染诊治循证指南(2016)[J].中华儿科杂志,2017,55(12):902-904.
[13]SAVAR N S,JAHANIAN-NAJAFABADI A,MAHDA-VI M,et al.In silico and in vivo studies of truncated forms of flagellin(FliC)of enteroaggregative Escherichia coli fused to FimH from uropathogenic Escherichia coli as a vaccine candidate against urinary tract infections[J].JBiotechnol,2014,175(8):31-37.