摘要
目的研究儿童泌尿系统感染病原菌分布及耐药状况,为临床合理用药提供依据。方法回顾性分析本院2005年1月-2007年12月573例疑为泌尿系统感染患儿中段尿细菌培养及药敏试验结果。细菌鉴定采用法国生物-梅里埃公司提供的ATB鉴定系统;药敏试验采用K-B琼脂扩散法,超广谱β-内酰胺酶(ESBLs)检测采取美国临床实验室标准化委员会(NCCLS)推荐的表型确诊试验;耐甲氧西林葡萄球菌(MRS)和氨基糖苷类高水平耐药的肠球菌(HLAR)按照NCCLS推荐的方法进行。结果573例尿培养分离出病原菌482株,阳性率为84.1%。其中革兰阴性(G-)杆菌385株,占79.9%,以大肠埃希菌(198株)为主,占41.1%;革兰阳性(G+)球菌97株,占20.1%,以肠球菌(71株)为主,占14.7%。大肠埃希菌和肺炎克雷伯杆菌对亚胺培南敏感,对头孢哌酮/舒巴坦、阿米卡星、呋喃妥因耐药率低于9.7%,对临床常用的哌拉西林、头孢他啶、环丙沙星、复方磺胺甲唑等耐药率高于50%,ESBLs检出率分别为59.2%、52.7%;铜绿假单胞菌呈高度多重耐药;肠球菌对万古霉素敏感,对呋喃妥因耐药率低于8.1%,HLAR分离率为26.1%;葡萄球菌对万古霉素敏感,对呋喃妥因和利福平耐药率低于22.4%,MRS分离率为52.7%。结论儿童泌尿系统感染病原菌以G-杆菌为主,以大肠埃希菌为首,肠球菌及肺炎克雷伯杆菌分别居第二、第三。病原菌对常用抗生素呈高度耐药,多重耐药现象严重。临床应重视病原菌检测及药敏试验,为准确诊断及合理使用抗生素提供依据。
Objective To investigate the distribution and drug resistance of pathogenic bacteria in children with urinary tract infection. Methods All data were analyzed retrospectively. Middle segment urine samples from 573 outpatients and inpatients in children were collected, cultured and identified for pathogenic bacteria by the way of ATB apparatus during Jan. 2005 - Dec. 2007, and the drug resistance of positively cultured bacteria was tested with disc agar diffusion method. Extended spectrum β- lactamases （ESBLs） were determined by phenotypic comfirmatory test according to the criteria of National Committee for Clinical Laboratory （ NCCLS）, and the identifications of methicillin - resistant staphylococcus aureus（MRS） and high level aminoglycoside resistance（HLAR） were carried out by the methods recommended from NCCLS too. Results Four hundred and eighty - two pathogenic strains were isolated from urine culture of children during 3 years, in which 385 strains （79.9%） were gram - negative （G^-） and 97 strains （20. 1% ） were gram - positve（G^＋ ）. The primary G^- bacterium was Esche- richia coli which accounted for 41. 1% （ 198 strains） ,and the primary G^＋ bacterium was Enterococcus which accounted for 14.7% （71 strains）. All the strains of Escherichia coli and klebsiella pneumoniae were sensitive to imipenem. Their resistance rates to sulperazone, amikacin and nitrofurantoin were less than 9.7%, while the rates to piperacillin, ceftazidime, ciprofloxacin and trimethoprim -sulfamethoxazole were more than 50%. ESBLs - producing strains accounted for 59.2% in Escherichia coli and 52.7% in klebsiella pneumoniae. Pseudomonas aeruginosa showed high multi - drug resistance. All the Enterococcus strains were sensitive to vancomycin. The resistance rate to nitrofurantoin was less than 8.1%. The detection rate of HLAR was 26.1%. All the Staphylococcus strains were sensitive to vancomycin. The resistance rate to nitrofurantoin and rifampicin were less than 22.4%. The detection rate of MRS was 52.7%. Conclusions The primary pathogenic bacterium in children with urinary tract infection is G^- bacteria. The Eseheriehia eoli is the first, the Enterococcus is the second and the klebsiella pneumoniae is the third. All the pathogenic strains show high drug resistance to antibiotics in common use, therefore, clinicians should attach importance to the results from bacteria culture and susceptibility test,in order to obtian reference for accurate clinical diagnosis and rational use of antibiotics.
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2009年第11期857-858,共2页
Journal of Applied Clinical Pediatrics
关键词
泌尿系统感染
菌群分布
耐药性
儿童
urinary tract infection
distribution of bacteria group
drug resistance
child
