摘要
目的了解上海地区单中心儿童尿路感染常见病原菌的分布及耐药性,为临床经验性抗菌药物的选择提供依据。方法回顾性分析2016年1月至2019年12月复旦大学附属儿科医院收治的0~14岁尿路感染患儿的临床资料、尿培养和药物敏感试验结果,并根据发病年份、有无合并因素进行分组,比较不同组间常见病原菌的分布和耐药情况。统计学分析采用χ^(2)检验。结果共纳入1832例患儿,其中尿培养阳性1042例,阳性率为56.9%。检出前五位的病原菌分别是大肠埃希菌(375株,36.0%)、屎肠球菌(164株,15.7%)、肺炎克雷伯菌(133株,12.8%)、粪肠球菌(95株,9.1%)和铜绿假单胞菌(44株,4.2%)。革兰阴性菌年分离率(65.3%~72.9%)始终高于革兰阳性菌(22.6%~30.1%)。各年份间不同病原菌分布差异无统计学意义(χ^(2)=27.79,P=0.146)。在复杂性尿路感染患儿中,铜绿假单胞菌[5.8%(40/688)比1.1%(4/354)]和真菌[6.5%(45/688)比1.7%(6/354)]的检出率分别高于单纯性尿路感染,差异均有统计学意义(χ^(2)=12.68、11.79,均P<0.050)。大肠埃希菌和肺炎克雷伯菌对氨苄西林耐药率最高,分别为87.2%(301/345)和87.1%(115/132)。大肠埃希菌对阿米卡星、呋喃妥因、磷霉素、头孢美唑、哌拉西林/他唑巴坦、厄他培南、亚胺培南和美罗培南的耐药率分别为1.4%(5/345)、6.1%(21/345)、6.1%(21/345)、8.3%(11/132)、11.6%(40/345)、6.4%(22/345)、4.6%(16/345)和4.6%(16/345),肺炎克雷伯菌对以上药物的耐药率分别为6.1%(8/132)、37.9%(50/132)、15.2%(20/132)、23.2%(13/56)、26.5%(35/132)、23.5%(31/132)、17.4%(23/132)和16.7%(22/132),均高于大肠埃希菌,差异均有统计学意义(χ^(2)=6.02、76.17、9.99、7.94、16.04、28.29、20.79、18.84,均P<0.050)。铜绿假单胞菌对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、头孢他啶的耐药率分别为6.8%(3/44)、4.5%(2/44)、2.3%(1/44),对碳青霉烯类抗菌药物、阿米卡星和环丙沙星的耐药率均为0(0/44)。屎肠球菌对氨苄西林的耐药率达96.8%(153/158),而粪肠球菌对氨苄西林的耐药率为9.1%(8/88),未发现耐万古霉素、替考拉宁、利奈唑胺的肠球菌菌株。2016年至2019年大肠埃希菌和肺炎克雷伯菌对β-内酰胺类(包括碳青霉烯类)抗菌药物的耐药率呈下降趋势。结论革兰阴性菌仍是儿童尿路感染的主要病原菌,常见革兰阴性菌对β-内酰胺类(包括碳青霉烯类)抗菌药物的耐药率呈下降趋势。
Objective To investigate the distribution and antimicrobial resistance patterns of common pathogens in children with urinary tract infections in a single center in Shanghai,and to provide basis for the selection of empirical antibiotics in the clinical practice.Methods The clinical data,urine culture and drug sensitivity tests results of children with urinary tract infections between 0 to 14 years admitted to the Children′s Hospital of Fudan University from January 2016 to December 2019 were retrospectively analyzed.According to the time of onset and the complicated factors,the patients were divided into different groups.The distributions and antimicrobial resistance patterns of common pathogens were compared among the groups.The chi-square test was used for statistical analysis.Results Among the 1832 children,1042 cases had positive urine culture,with the culture positive rate of 56.9%.The top five pathogens detected were Escherichia coli(375 strains,36.0%),Enterococcus faecium(164 strains,15.7%),Klebsiella pneumoniae(133 strains,12.8%),Enterococcus faecalis(95 strains,9.1%)and Pseudomonas aeruginosa(44 strains,4.2%).The annual detection rates of gram-negative bacteria(65.3% to 72.9%)were always higher than those of gram-positive bacteria(22.6% to 30.1%).The distributions of pathogens among the years were not significantly different(χ^(2)=27.79,P=0.146).In patients with complicated urinary tract infections,the detection rates of Pseudomonas aeruginosa(5.8%(40/688)vs 1.1%(4/354))and fungi(6.5%(45/688)vs 1.7%(6/354))were significantly higher than those in patients with simple urinary tract infections(χ^(2)=12.68 and 11.79,respectively,both P<0.050).Both of Escherichia coli and Klebsiella pneumoniae had the highest resistance rates to ampicillin,which were 87.2%(301/345)and 87.1%(115/132),respectively.The resistance rates of Escherichia coli to amikacin,nitrofurantoin,fosfomycin,cefmetazole,piperacillin/tazobactam,ertapenem,imipenem and meropenem were 1.4%(5/345),6.1%(21/345),6.1%(21/345),8.3%(11/132),11.6%(40/345),6.4%(22/345),4.6%(16/345)and 4.6%(16/345),respectively.The resistance rates of Klebsiella pneumoniae to these drugs were 6.1%(8/132),37.9%(50/132),15.2%(20/132),23.2%(13/56),26.5%(35/132),23.5%(31/132),17.4%(23/132)and 16.7%(22/132),respectively,which were all higher than those of Escherichia coli,and the differences were all statistically significant(χ^(2)=6.02,76.17,9.99,7.94,16.04,28.29,20.79 and 18.84,respectively,all P<0.050).The resistance rates of Pseudomonas aeruginosa to cefoperazone/sulbactam,piperacillin/tazobactam and ceftazidime were 6.8%(3/44),4.5%(2/44)and 2.3%(1/44),respectively,while those to carbapenems,amikacin and ciprofloxacin were all 0(0/44).The resistance rate of Enterococcus faecium to ampicillin was 96.8%(153/158),while that of Enterococcus faecalis was 9.1%(8/88).There was no Enterococcus strain resistant to vancomycin,teicoplanin or linezolid.When dynamically comparing the trends of the antimicrobial resistance from 2016 to 2019,the resistance rates of Escherichia coli and Klebsiella pneumoniae to β-lactams(including carbapenems)antimicrobial agents had shown a downward trend.Conclusions Gram-negative bacteria are still the main pathogens of urinary tract infections in children,with a downward trend of drug resistance rates toβ-lactams(including carbapenems)antimicrobial agents.
作者
黄晶晶
叶颖子
俞蕙
沈茜
毕允力
王传清
Huang Jingjing;Ye Yingzi;Yu Hui;Shen Qian;Bi Yunli;Wang Chuanqing(Department of Infectious Diseases,National Children's Medical Center,Children's Hospital of Fudan University,Shanghai 201102,China;Department of Nephrology,National Children's Medical Center,Children's Hospital of Fudan University,Shanghai 201102,China;Department of Urology,National Children's Medical Center,Children's Hospital of Fudan University,Shanghai 201102,China;Microbiology Department of Clinical Medical Laboratory,National Children's Medical Center,Children's Hospital of Fudan University,Shanghai 201102,China)
出处
《中华传染病杂志》
CAS
CSCD
2022年第2期71-78,共8页
Chinese Journal of Infectious Diseases
关键词
泌尿道感染
儿童
抗菌药
病原菌
耐药率
Urinary tract infections
Child
Anti-bacterial agents
Pathogenic bacteria
Resistance
作者简介
通信作者:叶颖子,Email:yeyingzi1502@sina.com。
