儿童原发性肾病综合征合并尿路感染的病原菌及耐药性分析

目的探讨原发性肾病综合征（PNS）合并尿路感染（UTI）患儿的病原菌分布及其耐药性，为临床合理使用抗菌药物提供参考。方法以2009年1月-2012年12月住院治疗且尿液细菌培养阳性的218例PNS合并UTI患儿为研究对象，回顾性分析致病菌分布和药物敏感（药敏）情况。结果75．7％（165／218）的PNS患儿表现为无症状UTI。共分离培养出249株致病菌，G-杆菌是PNS合并UTI的主要致病菌，占64.3％（160／249），其中63．8％（102／160）的致病菌为大肠埃希菌；G＋球菌占31．7％（79／249），其中59．5％（47／79）为粪肠球菌，真菌占4．0％。药敏结果提示，大肠埃希菌对羟苄西林、头孢唑林和头孢曲松等耐药率高（〉50％），而对头孢哌酮／舒巴坦钠和亚胺培南等耐药率低（〈10％）。粪肠球菌对利福平耐药率（74．6％）高，而对万古霉素和利奈唑胺等耐药率低（〈10％）。结论PNS患儿多表现为无症状UTI，大肠埃希菌是其主要致病菌，但肠球菌感染的比例亦不低，这些致病菌对常规抗菌药物耐药明显且多数为多药耐药。

Pathogens and Antibiotic Resistance Analysis of Primary Nephrotic Syndrome Complicated with Urinary Tract Infection in Children

Objective To investigate the distribution and antibiotic resistance of pathogens isolated from children with primary nephrotic syndrome （PNS） complicated with urinary tract infection （UTI）, so as to provide references for reasonable use of anti-infective agents in clinical practice. Methods A total of 218 eligible patients who hospitalized in our department between January 2009 and December 2012 were included, and the data of distribution and antibiotic resistance of pathogens were analyzed retrospectively. Results In this cohort, asymptomatic UTI in children with PNS accounted for 75.7% （165/218）. And a total of 249 pathogenic strains were isolated and cultivated. The main pathogens of those subjects were G- bacilli, accounting for 64.3% （160/249）, and 63.8% （102/160） of Gbacilli was Escherichia coli （E.coli）; G＋ cocci accounted for 31.7% （79/249）, and 59.5% （47/79） of them was Enterococcifaecalis; and fungi accounted for only 4.0%. Drug-susceptibility testing suggested that E.coli had a high resistance rate to hydroxyl ampicillin, cefazolin and ceftriaxone （ 〉 50%）, but had lower resistance rate to cefoperazone/sulbactam and imipenem （〈 10%）. Enterococcifaecalis had a high resistance rate to rifampicin （74.6%）, but had low resistance to vancomycin and linezolid （〈 10%）. Conclusions Asymptomatic UTI is common in children with PNS. E.coli is the major pathogen and the proportion of enterococcus infection is also not low, and these pathogens have a high antibiotic resistance and most of them are multi-resistant.