中华传染病杂志
中華傳染病雜誌
중화전염병잡지
CHINESE JOURNAL OF INFECTIOUS DISEASES
2011年
12期
735-739
,共5页
殷丽军%王爱敏%薛建昌%宋建明%何磊燕%王传清
慇麗軍%王愛敏%薛建昌%宋建明%何磊燕%王傳清
은려군%왕애민%설건창%송건명%하뢰연%왕전청
泌尿道感染%肠球菌属%氨苄西林%微生物敏感性试验%抗药性,细菌%儿童
泌尿道感染%腸毬菌屬%氨芐西林%微生物敏感性試驗%抗藥性,細菌%兒童
비뇨도감염%장구균속%안변서림%미생물민감성시험%항약성,세균%인동
Urinary tract infections%Enterococcus%Ampicillin%Microbial sensitivity tests%Drug resistance,bacterial%Child
目的 了解泌尿道感染患儿病原菌的构成和耐药变化.方法 以复旦大学附属儿科医院2001年1月至2010年12月间临床诊断为泌尿道感染的患儿为研究对象,对尿液进行细菌培养和鉴定.药物敏感试验采用琼脂扩散法(KB).计数资料采用卡方检验,耐药率的趋势变化采用曲线回归分析.结果 10年间共分离到10 686株致病菌,致病菌构成比分析显示,大肠埃希菌的分离率最高,为38％～56％.粪肠球菌从0升至17％ (F=34.075,P=0.000),屎肠球菌从3％升至15％(F=7.139,P=0.028).大肠埃希菌对头孢唑啉、头孢呋辛钠、头孢噻肟、头孢他啶的耐药率呈上升趋势,分别从35.8％上升至62.3％(F=215.735,P=0.000)、33.1％上升至57.0％(F=70.674,P=0.000)、19.0％上升至56.5％(F=52.355,P=0.000)、2.1％上升至23.5％(F=16.807,P=0.003)；大肠埃希菌对环丙沙星的耐药率在23.4％～33.8％(F=20.989,P=0.349),对阿米卡星及头孢哌酮/舒巴坦的耐药率均不超过7％,未发现对亚胺堵南耐药.屎肠球菌对氨苄西林、环丙沙星的耐药率分别超过60.0％及50.0％,对呋喃妥因的耐药率从32.0％降到9.4％(F=34.075,P=0.000).粪肠球菌对氨苄西林的耐药率由40.0％降到9.6％(F=17.497,P=0.009),对环丙沙星的耐药率从60.0％降到21.6％(F=12.826,P=0.009),对呋喃妥因的耐药率从9.2％降到1.4％(F=7.139,P=0.028).两种肠球菌对红霉素的耐药率均超过75.0％,未发现对万古霉素耐药的肠球菌.结论 大肠埃希菌、粪肠球菌、屎肠球菌是儿童泌尿道感染的三种主要致病菌,肠球菌在泌尿道感染致病菌中的构成比呈上升趋势.氨苄西林对粪肠球菌仍敏感,而屎肠球菌可选择药物已很少.
目的 瞭解泌尿道感染患兒病原菌的構成和耐藥變化.方法 以複旦大學附屬兒科醫院2001年1月至2010年12月間臨床診斷為泌尿道感染的患兒為研究對象,對尿液進行細菌培養和鑒定.藥物敏感試驗採用瓊脂擴散法(KB).計數資料採用卡方檢驗,耐藥率的趨勢變化採用麯線迴歸分析.結果 10年間共分離到10 686株緻病菌,緻病菌構成比分析顯示,大腸埃希菌的分離率最高,為38％～56％.糞腸毬菌從0升至17％ (F=34.075,P=0.000),屎腸毬菌從3％升至15％(F=7.139,P=0.028).大腸埃希菌對頭孢唑啉、頭孢呋辛鈉、頭孢噻肟、頭孢他啶的耐藥率呈上升趨勢,分彆從35.8％上升至62.3％(F=215.735,P=0.000)、33.1％上升至57.0％(F=70.674,P=0.000)、19.0％上升至56.5％(F=52.355,P=0.000)、2.1％上升至23.5％(F=16.807,P=0.003)；大腸埃希菌對環丙沙星的耐藥率在23.4％～33.8％(F=20.989,P=0.349),對阿米卡星及頭孢哌酮/舒巴坦的耐藥率均不超過7％,未髮現對亞胺堵南耐藥.屎腸毬菌對氨芐西林、環丙沙星的耐藥率分彆超過60.0％及50.0％,對呋喃妥因的耐藥率從32.0％降到9.4％(F=34.075,P=0.000).糞腸毬菌對氨芐西林的耐藥率由40.0％降到9.6％(F=17.497,P=0.009),對環丙沙星的耐藥率從60.0％降到21.6％(F=12.826,P=0.009),對呋喃妥因的耐藥率從9.2％降到1.4％(F=7.139,P=0.028).兩種腸毬菌對紅黴素的耐藥率均超過75.0％,未髮現對萬古黴素耐藥的腸毬菌.結論 大腸埃希菌、糞腸毬菌、屎腸毬菌是兒童泌尿道感染的三種主要緻病菌,腸毬菌在泌尿道感染緻病菌中的構成比呈上升趨勢.氨芐西林對糞腸毬菌仍敏感,而屎腸毬菌可選擇藥物已很少.
목적 료해비뇨도감염환인병원균적구성화내약변화.방법 이복단대학부속인과의원2001년1월지2010년12월간림상진단위비뇨도감염적환인위연구대상,대뇨액진행세균배양화감정.약물민감시험채용경지확산법(KB).계수자료채용잡방검험,내약솔적추세변화채용곡선회귀분석.결과 10년간공분리도10 686주치병균,치병균구성비분석현시,대장애희균적분리솔최고,위38％～56％.분장구균종0승지17％ (F=34.075,P=0.000),시장구균종3％승지15％(F=7.139,P=0.028).대장애희균대두포서람、두포부신납、두포새우、두포타정적내약솔정상승추세,분별종35.8％상승지62.3％(F=215.735,P=0.000)、33.1％상승지57.0％(F=70.674,P=0.000)、19.0％상승지56.5％(F=52.355,P=0.000)、2.1％상승지23.5％(F=16.807,P=0.003)；대장애희균대배병사성적내약솔재23.4％～33.8％(F=20.989,P=0.349),대아미잡성급두포고동/서파탄적내약솔균불초과7％,미발현대아알도남내약.시장구균대안변서림、배병사성적내약솔분별초과60.0％급50.0％,대부남타인적내약솔종32.0％강도9.4％(F=34.075,P=0.000).분장구균대안변서림적내약솔유40.0％강도9.6％(F=17.497,P=0.009),대배병사성적내약솔종60.0％강도21.6％(F=12.826,P=0.009),대부남타인적내약솔종9.2％강도1.4％(F=7.139,P=0.028).량충장구균대홍매소적내약솔균초과75.0％,미발현대만고매소내약적장구균.결론 대장애희균、분장구균、시장구균시인동비뇨도감염적삼충주요치병균,장구균재비뇨도감염치병균중적구성비정상승추세.안변서림대분장구균잉민감,이시장구균가선택약물이흔소.
Objective To investigate the distribution and evolvement of resistance profiles of the pathogens isolated from children diagnosed with urinary tract infection (UTI).Methods The pediatric patients who were diagnosed with UTI in Children's Hospital of Fudan University from January 2001 to December 2010 were enrolled in this retrospective study.The clean catch midstream urine samples were collected and the pathogens were isolated by culture.Bacterial susceptibility test was performed by following a protocol of the standardized Kirby Bauer (KB) method.The enumeration data were analyzed by chi square test and the tendency of drug resistant rate was analyzed by curvilinear regression.Results A total of 10 686 pathogen strains were isolated during the past 10years.The major pathogen was Escherichia coli which counted for 38％ -56％ of the isolates.However,the proportion of Enterococcus faecalis (0 - 17％,F =34.075,P =0.000) and Enterococcus faecium (3 ％ - 15 ％,F =7.139,P =0.028) increased rapidly.The resistant rates of Escherichia coli to cefazolin,cefuroxime sodium,cefotaxime and ceftazidime were 35.8％- 62.3％(F=215.735,P=0.000),33.1％ -57.0％(F=70.674,P=0.000),19.0％ -56.5％(F=52.355,P=0.000) and 2.1％-23.5％(F=16.807,P=0.003),respectively.The resistant rate of Escherichia coli to ciprofloxacin was 23.4％ - 33.8 ％ (F=0.989,P=0.349),while the resistant rate of Escherichia coli to amikacin and cefoperozone/sulbactam were both less than 7％.There was no Escherichia coli isolate showing resistant to imipenem.The resistant rates of Enterococcus faecium to ampicillin and ciprofloxacin were higher than 60.0％ and 50.0％,respectively,while the resistant rate of Enterococcus faecalis to these two antibiotics decreased from 40.0％ to 9.6 ％ (F =17.497,P =0.009) and 60.0％ to 21.6％ (F=12.826,P=0.009),respectively.The resistant rate of Enterococcus faecium to nitrofurantoin decreased from 32 ％ (in the year of 2002) to 9.4％ (in the year of 2010,F=34.075,P=0.000) and the resistant rate of Enterococcus faecalis decreased from 9.2％ (in the year of 2005) to 1.4％ (in the year of 2010,F=7.139,P=0.028).The resistant rates to erythromycin were both higher than 75.0％ in both Enterococcus in recent 10 years.There was no Enterococcus isolates showing resistant to vancomycin.Conclusions Escherichia coli,Enterococcus faecalis and Enterococcus faecium are the most common pathogens associated with UTI in children.The proportions of Enterococcus faecalis and Enterococcus faecium among the pathogens of UTI are increasing.The antimicrobial activity of ampicillin to Enterococcus faecalis keeps at a high level.However,there are few drugs can be used for treating Enterococcus faecium infection.
