尿路感染与尿路结石的相关性研究

目的：探讨尿路感染与尿路结石的相互关系。方法：收集120例经开放手术或腹腔镜手术取出尿路结石的住院患者。所有患者术前连续3天取晨尿行中段尿培养,术中取结石处尿液行细菌培养,取出的结石行消毒前培养和消毒后培养。结果：120例尿路结石,感染石占38例（31．6％）。感染石细菌种类以大肠埃希菌和表皮葡萄球菌为主。38例感染石由厌氧培养法检出25例（65．8％）,普通培养法检出13例（34．2％）,差异有统计学意义（P〈0．05）。术中结石处尿液细菌培养阳性仅见于感染石患者,且菌种与结石菌种相同。感染石与非感染石患者的中段尿、术中尿细菌培养阳性比例分别为44．7％、68．4％和4．9％、0％,临床尿路感染发生率分别为18．4％和2．4％,差异有统计学意义,P〈0．01。38例感染石中37例合并上尿路梗阻,而且7例有临床尿路感染的患者均合并上尿路梗阻。结论：感染石容易导致尿路感染。伴有上尿路梗阻的结石比不伴有上尿路梗阻的结石与微生物有更密切的关系。感染石常伴有亚临床尿路感染。常见尿路致病菌的培养基和培养方法有待进一步改进,以血液增菌液作为培养基,并采用厌氧培养法更有利于细菌生长。     

Vesicoureteric reflux and urinary tract infection in children

An association between vesicoureteric reflux (VUR) and renal damage was found in 1960. In 1973, the term reflux nephropathy (RN) was first used to describe the renal damage caused by VUR. Follow up studies show that about 10%-20% of children with RN develop hypertension or end stage renal disease. It is now evident that there is a sex difference in the development of RN. In most males with RN, the kidneys are congenitally abnormal. In females it is an acquired condition, the most severe damage being sustained by recurrent urinary tract infections (UTIs). The purpose of current UTI guidelines is to identify VUR or any other abnormality of the urinary tract. Since the advent of routine antenatal ultrasonography, there is no longer a need to identify an abnormality of the urinary tract after the first reported UTI. Routine investigations are not required. Recurrent UTIs and a family history of VUR need further evaluation. There is also an urgent need to establish the long term value of prophylactic antibiotics in children with VUR.     

Management of urinary tract infection and vesico-ureteric reflux in children

Even though urinary tract infection is common in childhood, its diagnosis and management can be difficult. One must be aware of factors that may interfere with urine culture result. Besides urinary stasis, renal tract abnormalities and detrusor instability, host factors and certain strains of invading organisms (P-fimbriated E Coli) may be important in the pathogenesis of urinary trace infection. The choice of antibiotics for treatment of urinary tract infection should be guided by the age of the patient, clinical presentation and urine culture result. The management of vesico-ureteric reflux depends on its grading. Grade I and II can be treated medically by long-term low dose antibiotics because spontaneous resolution is high. For Grade III and IV, the treatment of choice is controversial. Controlled prospective studies showed that surgical reimplantation did not prevent new scar formation, progression of old scars and breakthrough infection. Endoscopic submeteric injection of Teflon is a new method to correct vesico-ureteric reflux. Despite favourable short-term results, the long-term outcome is unknown.     

Association between diaphragm use and urinary tract infection

We conducted independent case-control and retrospective cohort investigations to assess the relationship between diaphragm use and urinary tract infection (UTI). In the former, we compared diaphragm use and vaginal flora among 114 women with acute UTI and 85 women with acute urinary tract symptoms and no UTI. In the latter study, we ascertained the incidence of UTI in 192 diaphragm users and 182 women taking oral contraceptives during a mean follow-up of 9.4 months. Both studies demonstrated a significantly increased risk of UTI in diaphragm users: relative odds were 2.0 in the case-control study and the relative risk was 2.5 in the retrospective cohort study. Vaginal colonization with Escherichia coli was significantly greater in diaphragm users. The incidence of UTI in the cohort study was 26.6 per 1,000 patient-months for diaphragm users and 8.9 per 1,000 patient-months for women taking oral contraceptives. The increased risk of UTI in diaphragm users could not be attributed to differences in age, parity, sexual activity, or previous UTI.     

Antibiotic resistance in children with complicated urinary tract infection

OBJECTIVE: To determine the resistance of antibiotics for complicated urinary tract infection (UTI), including urinary tract anomaly (UTA), for empirical antibiotic therapy of complicated UTI. METHODS: Four hundred and twenty urine isolates were obtained from 113 patients with recurrent UTI, who used prophylactic antibiotics between February 1999 and November 2004 in the Eskisehir Osmangazi University, Eskisehir, Turkey. RESULTS: Reflux was found to be the most important predisposing factor for recurrent UTI (31.9%). Renal scar was detected more in patients with UTA than without UTA (59.2% versus 12.4%, p<0.05). Gram-negative organisms were dominant in patients with and without UTA (91.5% and 79.2%). Enterococci and Candida spp. were more prevalent in children with UTA than without UTA (p<0.001). Isolates were significantly more resistant to ampicillin, trimethoprim-sulfamethoxazole, amikacin, co-amoxiclav, ticarcillin-clavulanate, and piperacillin-tazobactam in patients with UTA than without UTA. We found low resistance to ciprofloxacin and nitrofurantoin in UTI with and without UTA. Enterococci spp. was highly resistance to ampicillin and amikacin in patients with UTA. CONCLUSION: Aztreonam, meropenem, and ciprofloxacin seemed to be the best choice for treatment of UTI with UTA due to Escherichia coli and Klebsiella spp. Nitrofurantoin and nalidixic acid may be first choice antibiotics for prophylaxis in UTI with and without UTA. The UTI with UTA caused by Enterococci spp. might not benefit from a combination of amikacin and ampicillin, it could be treated with glycopeptides.     

Prevalence of cryptosporidium infection among undernourished children in Jos, Central Nigeria

This prospective study aimed at determining the prevalence data of Cryptosporidium infection in undernourished children, its seasonality and its relative frequency in diarrhoeic stool in Jos, Central Nigeria. One hundred and seventy each of undernourished and well nourished children aged 0-5 years were recruited into the study. Stool samples and clinical data were obtained using questionnaires. Results were analysed using Chi-square test. The prevalence of the infection was found to be 4.8% and all infections occurred in diarrhoeic stool. No infection with this pathogen was recorded in the well-nourished group. There was a defined seasonality of the infection. The high prevalence suggests the importance of introducing routine screening of this group of patients for cryptosporidium infection to facilitate their management.     

维生素 D 受体基因启动子甲基 化异常与婴儿尿路感染相关性 研究

目的研究维生素D受体（VDR）基因启动子甲基化异常与婴儿尿路感染的关系。方法选择急性尿路感染患儿32例（尿路感染组）和同期健康体检婴儿30例（健康对照组）。采用荧光定量PCR法检测VDR、DNA甲基化转移酶（DNMTs）mRNA表达水平,重亚硫酸氢钠测序技术检测VDR基因启动子的甲基化水平。结果尿路感染组患儿VDRmRNA表达水平高于健康对照组婴儿,DNMT1mRNA表达水平低于健康对照组婴儿,两组比较差异均有统计学意义（均P＜0.05）。两组DNMT3a、DNMT3bmRNA表达水平比较差异均无统计学意义（均P＞0.05）。尿路感染组患儿VDR基因启动子甲基化水平显著低于健康对照组婴儿,两组比较差异有统计学意义（P＜0.05）。结论尿路感染患儿VDRmRNA表达水平升高,VDR基因启动子的甲基化水平降低,VDR基因甲基化异常与婴儿尿路感染相关。     

小儿泌尿系感染300例临床回顾分析

目的探讨小儿泌尿系感染的临床特点及致病菌的分布情况,为临床医生治疗该疾病提供理论依据。方法对2002—2012年该院儿科病房收治的300例泌尿系感染患儿的发病特点、实验室检查、治疗及转归进行分析。结果 300例患者,其中有13例因高热、水肿严重直接转上级医院,5例因疑似过敏性紫癜转院,另外5例因家属要求退院。145例尿培养前未应用过药物的患儿尿培养阳性率为62.07%,132例尿培养前应用过药物的患儿尿培养阳性率为20.45%,两者差异有统计学意义(P<0.05)。尿培养结果中大肠埃希菌94例,对丁胺卡那霉素和头孢哌酮的敏感率均在90%以上。结论抗生素的提前使用会降低尿培养的阳性率。小儿泌尿系感染的常见致病菌为大肠埃希菌,头孢哌酮可作为治疗该病的首选药物。     

小儿泌尿系统感染情况调查

泌尿系感染是指病原体直接侵入尿路,在尿液中生长繁殖,并侵犯尿道粘膜或组织而引起损伤。泌尿系是小儿常见的感染部位,尤其女性,由于其特殊的生理结构,更增加其感染的机会。严重的泌     

婴幼儿下呼吸道感染伴首次喘息发作与过敏原的关系

目的分析婴幼儿下呼吸道感染伴首次喘息发作与过敏原的关系,以期早期干预治疗。方法 83例下呼吸道感染婴幼儿依据是否喘息分为两组,采用瑞典Pharmacia Unicap 100全自动荧光免疫分析仪分别测定两组血清总IgE及过敏原d1、f1、f2特异性IgE抗体,同时统计喂养方式在两组间的差异。结果两组血清总IgE及过敏原d1、f1、f2特异性IgE抗体无统计学差异,两组间喂养方式无统计学差异。结论婴幼儿下呼吸道感染首次喘息发作机体并未形成高敏状态,不能应用过敏原检测来预测患儿是否发展为哮喘,喂养方式与是否喘息发作无相关。     

儿童泌尿系感染病原学及耐药现状的分析

目的 探讨目前儿童泌尿系感染致病菌和耐药性的变化.方法 分析2000年3月至2006年1月住院治疗的338例尿培养阳性的泌尿系感染患儿的临床情况、致病菌分布及其对抗生素的敏感性.结果 在597株尿阳性菌株中革兰阴性杆菌占68.0%,其中仍以大肠埃希菌为主,占40.2%;革兰阳性球菌占26.5%,其中肠球菌占17.8%;真菌占5.5%.革兰阴性杆菌对氨苄西林及其他多数头孢类抗生素普遍耐药率高;对亚胺培南耐药性最低,为0.8%,对氨基糖苷类、喹诺酮类、呋哺妥因及少部分第二、第三代头孢类抗生素耐药率相对较低,为11.5%～51.0%:肠球菌对万古霉素100%敏感.对呋喃妥因耐药率低.结论 大肠杆菌仍是住院小儿泌尿系感染的主要致病菌.条件致病菌感染增多,细菌耐药现象普遍,治疗前应尽量根据细菌药敏试验结果调整抗生素.     

儿童急性上呼吸道感染与中医证型体质及发病季节的关系

目的研究儿童急性上呼吸道感染与中医证型体质以及与发病季节之间的关系。方法对我院2015年1月-2017年1月急诊收治的134例儿童急性上呼吸道感染患者进行回顾性研究,分析探讨患儿不同中医证型(风寒束表证、暑湿袭表证、卫气同病证、风热犯表证、寒热夹杂证)与体质的关系和发病季节的关系。结果 134例患儿中风寒束表证46例,风热犯表证36例,寒热夹杂证22例,暑湿袭表证19例,卫气同病证11例。暑湿袭表证主要出现在湿热质和痰湿质的患儿中,风热犯表证和卫气同病证的患儿以阴虚质所占比率较大,风寒束表证表现的患儿主要以气虚质、阳虚质和气郁质的患儿所占比例较大。冬季发病患儿为最多,达57例,秋季为30例,夏季为27例,春季为20例,冬季发病率显著高于其他季节发病(P0.05)。夏季患病的患儿主要体质为痰湿质和湿热质为主;秋季患病的患儿主要体质为阴虚质为主;冬春季患病则以气虚质、阳虚质和气郁质患儿为主。结论儿童体质决定了患儿急性上呼吸道感染的中医证型,且患儿不同中医证型与发病季节间存在一定的相关性。