婴儿泌尿系感染的临床特点及病原菌分布

目的 研究婴儿泌尿系感染的临床特点及病原菌分布.方法 对2012年1月至2016年12月近5年来在西安市儿童医院肾脏科住院并确诊为泌尿系感染的96例婴儿的临床资料进行回顾性分析.结果 泌尿系感染患儿中,1岁以下的婴儿和1岁以上患儿的男女构成比差异有统计学意义(χ2=10.971,P<0.01),婴儿泌尿系感染中男62例(占64.58%),女34例(占35.42%).起病形式以发热及肉眼血尿起病最多见,27例(28.13%)均提示泌尿系畸形,其中包括重复肾、肾积水、肾结石、肾发育不良及膀胱输尿管返流等.32例尿培养阳性(阳性率为33.33%),其中革兰阴性菌20例(62.50%),大肠埃希菌12例(37.50%),肺炎克雷伯杆菌7例(21.88%),革兰阳性菌中肠球菌12例(37.50%).所有患儿积极抗感染治疗后,除1例自动出院失访外,其余患儿均预后良好.结论 婴儿泌尿系感染以男孩多见,临床表现多不典型,易合并泌尿系畸形,对婴儿泌尿系感染应常规行泌尿系超声以排除泌尿系畸形.在治疗中应重视寻求病因的同时针对病因进行治疗.

Clinical characteristics and pathogen distribution of urinary tract infection in infants

Objective To study the clinical characteristics and pathogen distribution of urinary tract infection (UTI) in infants.Methods Clinical data of 96 infants diagnosed with UTI and hospitalized in department of nephrology in Xi'an Children's Hospital from January 2012 to December 2016 were retrospectively analyzed.Results Among cases with UTI, difference in male and female constituent ratio in patients under 1 year and above 1 year old was statistically significant (χ2=10.971,P<0.01).Among infants with UTI , 62 cases were male (64.58%) and 34 were female (35.42%).The most common onset symptoms were fever and gross hematuria.Twenty-seven cases (28.13%) indicated urinary tract abnormalities, including duplex kidney, hydronephrosis, kidney stones, renal dysplasia and vesicoureteral reflux.Thirty-two cases had positive results of urine culture with positive rate of 33.33%, including 20 cases infected with gram-negative bacteria infection (62.50%), 12 cases with Escherichia coli (37.50%), 7 cases with klebsiella pneumoniae (21.88%) , and 12 cases with enterococcus (37.50%) among cases infected with gram-positive bacteria.Except 1 case leaving hospital voluntarily and lost to follow-up, all patients had good prognosis after active anti-infective treatment.Conclusion Infantile UTI is more common in male children.Its clinical manifestations are not typical and UTI is often combined with urinary tract abnormalities.Urinary system ultrasound should be done as routine check for infants with urinary system infection to exclude urinary system abnormality.During treatment, attention should be paid to etiological diagnosis and etiological treatment.