61例小儿原发性肾病综合征合并尿路感染的病原菌及耐药性分析

目的对近年原发性肾病综合征（PNS）合并尿路感染（UTI）的病原菌和耐药性进行分析,指导临床合理用药。方法回顾性分析近2年61例PNS合并UTI患儿的临床资料,了解病原菌的分布及耐药情况。结果PNS合并UTI患儿以无症状性菌尿者多见（85.25%）,男女发生率无显著性差异。病原菌以革兰阴性菌为主,大肠杆菌仍居首位（51.28%）,其次为阴沟肠杆菌及肠球菌,肠球菌较四川地区10年前比有上升趋势。对抗菌药物的敏感性大小,大肠杆菌依次为泰能、阿米卡星、哌拉西林他唑巴坦,阴沟肠杆菌依次为阿米卡星、泰能及美洛培南,二者对头孢类抗生素的敏感性均不高;肠球菌属对万古霉素和利奈唑烷的敏感性较高。革兰阴性菌超广谱β-内酰胺酶（ESBLs）的检出率为67.65%,大肠杆菌产ESBLs的阳性率为85.00%,ESBLs阳性菌对泰能、阿米卡星、哌拉西林他唑巴坦的敏感性较高,而对头孢吡肟、头孢他啶无敏感性。结论临床应根据药物敏感性试验结果合理选择抗菌药物。

Analysis of Pathogens and Drug-Resistance in Children Primary Nephrotic Syndrome Complicated with Urinary Tract Infection in 61 Cases

Objective To investigate the distribution and drug-resistance of pathogenic bacteria in children primary nephrotic syndrome（PNS） complicated with urinary tract infection（UTI） for guiding the rational drug use in clinic.Methods The retrospective analysis of 61 children patients with PNS complicated with UTI was performed to determine the pathogens distribution and drug-resistance.Results The cases of asymptomatic bacteriuria were more common（85.25%）,and the different sexes had no difference.The Gram-negative bacteria were most common,especially,E.Coli was the majority accounting for 51.28%.The proportion of Enterococcus had an upward trend compared to that 10 years ago in the same area.E.Coli was sensitive to tienam,amikacin,piperacillin/tazobactam,Enterobacter cloacae was sensitive to amikacin,tienam,meropenem.But Enterococcus feces was sensitive to vancomycin and linezolid.The isolated rate of bacteria producing extended spectrum β-lactamases（ESBLs） was 67.65%,the rate of E.Coli producing-ESBLs was 85.00%,which was obviously increased. They were sensitive to tienam,amikacin,piperacillin/tazobactam,while they were drug-resistant to cefepime and ceftazidime.Conclusion In children with PNS complicated with UTI,the cases of asymptomatic bacteriuria are more common.The Gram-negative bacteria are most common,in which E.Coli is the majority and sensitive to piperacillin/tazobactam,so piperacillin/tazobactam could be the first choice before the urine culture results.The detected rates of bacteria producing-ESBLs are increasing.The medicine should be adjusted according to the urine culture results in clinical treatment.