小儿肾盂积水术后尿路感染的细菌谱和药敏分析

目的:了解肾盂积水术后置管导致的尿路感染的细菌谱及药物敏感特点,以指导临床用药。方法:对190例术前尿培养为阴性的肾盂输尿管连接部梗阻伴肾盂积水患儿,在术后7天(拔除输尿管支架管前)作尿液培养,阳性者再作菌种鉴定及药敏试验。结果:121例尿培养阳性,阳性率为63.7%(121/190)。位于前3位的菌种分别为肠球菌(28.9%)、大肠埃希菌(18.2%)和葡萄球菌(14.9%)。大肠埃希杆菌产酶率为36.4%(8/22),肺炎克雷伯杆菌产酶率为36.4%(4/11)。药敏特点:大肠埃希菌和肺炎克雷伯杆菌对氨苄西林、第一代和第三代头孢菌素、磺胺类均有较高的耐药率,但对亚胺培南、呋喃妥因和丁胺卡那霉素敏感;ESBLs阳性者只对头孢霉素类的头孢替坦和碳青霉烯类的亚胺培南敏感。肠球菌对青霉素、庆大霉素、四环素、环丙沙星高度耐药,只对呋喃妥因、力奈唑烷和万古霉素敏感。葡萄球菌对青霉素、氨苄西林及耐青霉素酶的苯唑青霉素高度耐药;对第一代头孢菌素、大环内脂类、四环素、氨基糖甙类也不敏感,只对万古霉素和呋喃妥因敏感。热淋清颗粒口服2周后再次尿培养均为阴性。结论:肾盂积水术后置管导致尿路感染的细菌谱有其本身的特点。各种致病菌的多重耐药情况严重。热淋清颗粒治疗肾盂积水术后置管导致的尿路感染有良好的效果。

Analysis of bacterial distribution and resistance to antibiotics in children with urinary tract infection after pyeloplasty

Objective:To investigate bacterial distribution and antibiotics resistance in children who underwent pyeloplasty.Methods:On day 7 after pyeloplasty,middle-segment or suprapubic urine samples were collected from 190 children and identified for pathogenic bacteria and the drug-resistance of positively-cultrued bacteria was tested.Results:A total of 121 stains of bacterium isolated from 190 samples.The urinary tract infection was mainly caused by Enterococcus(28.9%),followed by E.Coli(18.2%),Staphylococcus(18.9%),and Klebsiella pneumoniae(36.4%).Concerning the drug-resistance of these positively-cultrued bacteria,E.Coli and Klebsiella pneumoniae were found to be highly resistant to ampicillin, the first and third generation cephalosporins,but Tienam,Nitrofurantion,Amikacin were effective for E.Coli and Klebsiella pneumoniae.Enterococcus was found to be highly resistant to penicillin,gentamycin,and ciprofloxacin;Staphylococcus was highly resistant to penicillin,ampicillin,Oxacillin sodium,the first generation cephalosporins,and erythromycin.Nitrofurantion,Vaneomycin were effective to both Enterococcus and Staphylococcus.The second urine sample was collected after two weeks' treatment with Relinqing,no pathogenic bacteria was found.Conclusions:The urinary tract infection was mainly caused by Enterococcus,E.Coli,Staphylococcus,and Klebsiella pneumoniae in children undergoing pyeloplasty.Sever multiple resistance to antibiotics was found frequently.Relinqing was effective for both gram negative and gram positive germs.