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目的:探讨小儿泌尿系统感染(UTI)病原菌分布、变迁及其耐药性,指导临床安全用药。方法:收集宁夏医科大学总医院儿科2008年1月至2013年12月UTI住院患儿223例,回顾性分析患儿的临床资料及尿培养结果。结果:223例患儿尿培养共检出细菌178株,以革兰阴性菌为主(70.22%),大肠埃希菌居首位(53.93%);其次为革兰阳性菌(28.65%),以屎肠球菌(12.36%)、粪肠球菌(4.49%)多见。对比2008年-2010年及2011年-2013年革兰阳性菌、革兰阴性菌总体分布及前5位致病菌分布情况,革兰阴性菌感染率一直高于革兰阳性菌;革兰阳性菌感染率有上升趋势,屎肠球菌明显增加(P<0.05)。在革兰阴性菌中,大肠埃希菌对氨苄西林耐药率最高,对哌拉西林/他唑巴坦、呋喃妥因、头孢替坦、头孢他啶较为敏感,对亚胺培南全部敏感;革兰阳性菌中屎肠球菌耐药性相对复杂,治疗可选用较敏感的万古霉素、利奈唑胺、替考拉宁。结论:小儿UTI病原菌仍以大肠埃希菌为常见致病菌;革兰阳性菌感染率有上升趋势,以屎肠球菌为主。临床应重视中段尿的培养,加强对病原菌及其耐药性的监测,以便合理选择敏感抗生素,减少耐药菌的产生。
Objective: To investigate the distribution, changes and drug resistance of pathogenic bacteria in children with urinary tract infection (UTI) and to guide clinical safe medication. Methods: Totally 223 pediatric patients admitted to UTI from January 2008 to December 2013 were collected from the General Hospital of Ningxia Medical University. The clinical data and urine culture results were retrospectively analyzed. Results: A total of 178 bacterial strains were detected in urine samples from 223 infants. Gram-negative bacteria was the most common (70.22%), Escherichia coli was the most common (53.93%), followed by Gram-positive bacteria (28.65%), Enterococcus faecium (12.36%), Enterococcus faecalis (4.49%) more common. Comparing the distribution of Gram-positive bacteria, Gram-negative bacteria and the top 5 pathogenic bacteria in Gram-positive bacteria in 2008-2010 and 2011-2013, the infection rate of Gram-negative bacteria was always higher than that of Gram-positive bacteria; Gram-positive The infection rate of bacteria showed an upward trend, and Enterococcus faecium significantly increased (P <0.05). Among Gram-negative bacteria, Escherichia coli was the most resistant to ampicillin and sensitive to piperacillin / tazobactam, nitrofurantoin, cefotetan and ceftazidime, all were sensitive to imipenem; Gram-positive Enterococcus faecium in bacteria resistance is relatively complex, the treatment can be used more sensitive to vancomycin, linezolid, teicoplanin. Conclusion: The pathogens of UTI in children are still common pathogens of Escherichia coli. The infection rate of Gram-positive bacteria is on the rise, especially Enterococcus faecium. Clinical should pay attention to the middle of urinary culture, strengthen the monitoring of pathogens and their resistance to a reasonable choice of sensitive antibiotics, reduce the generation of resistant bacteria.