标题：儿童多重耐药菌尿路感染的临床特点及病原菌分析

      作者：柯志聪 1，周广伦 2，李守林 2，杨志林 2，尹鉴淳 2    1.汕头大学医学院，广东 汕头 515041；2.深圳市儿童医院泌尿外科，广东 深圳 518038

      卷次： 2022年33卷15期

      【摘要】 目的 探讨儿童多重耐药菌尿路感染的临床特点和病原学分布及其药敏结果，为临床用药提供依据。方法 回顾性分析深圳市儿童医院2014年1月至2020年12月期间收治152例各类儿童多重耐药菌尿路感染病患儿的临床和实验室检查资料。结果 152例患儿中130例尿培养为产超广谱β-内酰胺酶(ESBLs)致病菌，其中99例为大肠埃希菌，31例为肺炎克雷伯菌；致病菌对头孢曲松、头孢克洛、美洛西林等的耐药率均为100%，对呋喃妥因敏感率为74.6%，对哌拉西林他唑巴坦钠敏感率为96.2%，对美罗培南敏感率为100%；此外，17例尿培养为革兰氏阴性耐碳青酶烯类致病杆菌，5例尿培养结果为耐甲氧西林金黄色葡萄球菌；152例患儿中129例合并泌尿系畸形，单纯性膀胱炎等为23例。结论 由多重耐药菌引起的尿路系统感染的儿童中，大部分合并泌尿系畸形，致病菌以革兰阴性杆菌为主，其中大肠埃希菌及肺炎克雷伯菌占多数。致病菌对青霉素、第一二三代头孢耐药率高；哌拉西林他唑巴坦对致病菌敏感性高，应注意评估致感因素并进行针对性治疗。
      【关键词】 儿童；尿路感染；耐药菌；泌尿系畸形；革兰阴性菌；革兰阳性菌
      【中图分类号】 R726.9 【文献标识码】 A 【文章编号】 1003—6350（2022）15—1975—04

Clinical characteristics and pathogenic bacteria analysis of urinary tract infection with multidrug-resistantbacteria in children.
KE Zhi-cong 1, ZHOU Guang-lun 2, LI Shou-lin 2, YANG Zhi-lin 2, YIN Jian-chun 2. 1. MedicalCollege of Shantou University, Shantou 515041, Guangdong, CHINA; 2. Department of Urology, Shenzhen Children'sHospital, Shenzhen 518038, Guangdong, CHINA
【Abstract】 Objective To investigate the clinical characteristics, etiological distribution, and drug sensitivity ofurinary tract infection (UTI) with multidrug-resistant bacteria in children, and to provide evidence for clinical drug use.Methods The clinical and laboratory examination data of 152 children with urinary tract infections caused by multi-drug-resistant bacteria in Shenzhen Children's Hospital from January 2014 to December 2020 were analyzed retrospec-tively. Results Among the 152 children, 130 had extended-spectrum β-lactamases (ESBLs)-producing bacteria byurine cultures, including 99 cases of Escherichia coli and 31 cases of Klebsiella pneumoniae. The drug resistance rate ofpathogenic bacteria to ceftriaxone, cefaclor, and mezlocillin was 100%, the sensitivity rate to nitrofurantoin was 74.6%,the sensitivity rate to piperacillin-tazobactam sodium was 96.2%, and the sensitivity rate to meropenem was 100%. In ad-dition, urine culture showed 17 cases of Gram-negative carbapenem-resistant pathogenic bacteria, and 5 cases of methi-cillin-resistant Staphylococcus aureus. Among the 152 children, 129 were complicated with urinary malformation and 23with simple cystitis. Conclusion Most of the children with urinary tract infection caused by multidrug-resistant bacte-ria are complicated with urinary malformations. The main pathogenic bacteria are Gram-negative bacteria, includingEscherichia coli and Klebsiella pneumoniae. The resistance rate of pathogenic bacteria to penicillin and the first-, second-and third-generation cephalosporins was high. Piperacillin tazobactam has high sensitivity to pathogenic bacteria. Weshould pay attention to the evaluation of pathogenic factors and targeted treatment.
      【Key words】 Children; Urinary tract infection; Drug-resistant bacteria; Urinary malformation; Gram-negativebacteria; Gram-positive bacteria