浙江医学
浙江醫學
절강의학
ZHEJIANG MEDICAL JOURNAL
2014年
20期
1687-1690
,共4页
余灵芳%陈敏广%杨青%庄捷秋
餘靈芳%陳敏廣%楊青%莊捷鞦
여령방%진민엄%양청%장첩추
大肠埃希菌%ESBLs%尿路感染%儿童
大腸埃希菌%ESBLs%尿路感染%兒童
대장애희균%ESBLs%뇨로감염%인동
Escherichia coli%Extended- Spectrum%β- Lactamases%Urinary tract infection%Children
目的：总结产超广谱β-内酰胺酶（Extended- Spectrum β- Lactamase，ESBLs）大肠埃希菌儿童尿路感染（Urinary tract infection，UTI）病例的临床特点及相关预测因素,旨在从临床特点中早期识别产ESBLs细菌感染病例，指导经验性治疗。方法收集195例尿培养阳性病例，对其中112例大肠埃希菌感染病例进行回顾性分析，对比产ESBLs组与非产ESBLs组的临床特点，采用字2检验及多元逐步logistic回归分析产ESBLs大肠埃希菌感染的预测因素。结果195例中，大肠埃希菌为112例(占57.44%)，其中产ESBLs菌株79例（占70.54%）。发病年龄＜2岁、培养前使用抗生素、存在尿路异常者更易致产ESBLs菌株感染，产ESBLs大肠埃希菌感染组年龄更小，培养前使用抗生素及存在尿路异常的比例更高，临床上发热、血CRP值升高的表现更显著，非产ESBLs大肠埃希菌组经验性治疗有效率较高，平均住院日更短（P＜0.05或0.01）。多因素logistic回归分析提示培养前使用抗生素、尿路异常、发热、血CRP升高为产ESBLs菌株感染的预测因素（OR =4.657、2.961、5.721、1.442，P＜0.05）。结论对于年龄＜2岁、发热性尿路感染、存在尿路异常，培养前使用过抗生素，血CRP值较高水平的病例，更有可能提示产ESBLs大肠埃希菌感染，可以选择β-内酰胺酶抑制剂复合物类抗生素或碳青霉烯类抗生素作为经验性治疗药物，而没有这些特点的病例，倾向于非产ESBLs大肠埃希菌感染，头孢三代抗生素可作为选择药物。
目的：總結產超廣譜β-內酰胺酶（Extended- Spectrum β- Lactamase，ESBLs）大腸埃希菌兒童尿路感染（Urinary tract infection，UTI）病例的臨床特點及相關預測因素,旨在從臨床特點中早期識彆產ESBLs細菌感染病例，指導經驗性治療。方法收集195例尿培養暘性病例，對其中112例大腸埃希菌感染病例進行迴顧性分析，對比產ESBLs組與非產ESBLs組的臨床特點，採用字2檢驗及多元逐步logistic迴歸分析產ESBLs大腸埃希菌感染的預測因素。結果195例中，大腸埃希菌為112例(佔57.44%)，其中產ESBLs菌株79例（佔70.54%）。髮病年齡＜2歲、培養前使用抗生素、存在尿路異常者更易緻產ESBLs菌株感染，產ESBLs大腸埃希菌感染組年齡更小，培養前使用抗生素及存在尿路異常的比例更高，臨床上髮熱、血CRP值升高的錶現更顯著，非產ESBLs大腸埃希菌組經驗性治療有效率較高，平均住院日更短（P＜0.05或0.01）。多因素logistic迴歸分析提示培養前使用抗生素、尿路異常、髮熱、血CRP升高為產ESBLs菌株感染的預測因素（OR =4.657、2.961、5.721、1.442，P＜0.05）。結論對于年齡＜2歲、髮熱性尿路感染、存在尿路異常，培養前使用過抗生素，血CRP值較高水平的病例，更有可能提示產ESBLs大腸埃希菌感染，可以選擇β-內酰胺酶抑製劑複閤物類抗生素或碳青黴烯類抗生素作為經驗性治療藥物，而沒有這些特點的病例，傾嚮于非產ESBLs大腸埃希菌感染，頭孢三代抗生素可作為選擇藥物。
목적：총결산초엄보β-내선알매（Extended- Spectrum β- Lactamase，ESBLs）대장애희균인동뇨로감염（Urinary tract infection，UTI）병례적림상특점급상관예측인소,지재종림상특점중조기식별산ESBLs세균감염병례，지도경험성치료。방법수집195례뇨배양양성병례，대기중112례대장애희균감염병례진행회고성분석，대비산ESBLs조여비산ESBLs조적림상특점，채용자2검험급다원축보logistic회귀분석산ESBLs대장애희균감염적예측인소。결과195례중，대장애희균위112례(점57.44%)，기중산ESBLs균주79례（점70.54%）。발병년령＜2세、배양전사용항생소、존재뇨로이상자경역치산ESBLs균주감염，산ESBLs대장애희균감염조년령경소，배양전사용항생소급존재뇨로이상적비례경고，림상상발열、혈CRP치승고적표현경현저，비산ESBLs대장애희균조경험성치료유효솔교고，평균주원일경단（P＜0.05혹0.01）。다인소logistic회귀분석제시배양전사용항생소、뇨로이상、발열、혈CRP승고위산ESBLs균주감염적예측인소（OR =4.657、2.961、5.721、1.442，P＜0.05）。결론대우년령＜2세、발열성뇨로감염、존재뇨로이상，배양전사용과항생소，혈CRP치교고수평적병례，경유가능제시산ESBLs대장애희균감염，가이선택β-내선알매억제제복합물류항생소혹탄청매희류항생소작위경험성치료약물，이몰유저사특점적병례，경향우비산ESBLs대장애희균감염，두포삼대항생소가작위선택약물。
Objective To investigate the clinical characteristics and predictive factors of urinary tract infections (UTIs) in children caused by Extended- Spectyumβ- Lactamase (ESBLs)- producing Escherichia coli (E.coli), and to distinguish cases caused by ESBLs- producing E.coli earlier,and guide the empirical therapy. Methods 195 patients with positive urine culture in our children hospital from January 2011 to December 2012 were included. The clinical characteristics and predictive factors of UTIs caused by ESBLs- producing E.coli were analyzed by Chi- square test and multivariate logistic regression analysis. Results A total of 195 uropathogens were isolated, dominant with E.coli (n=112, 57.44%), including 79 (70.54%) ESBLs- pro-ducing strains.The patients with younger age (<2 years old), urinary tract anomalies, or had the history of antibiotic use be-fore urine culture were more likely be infected with ESBLs- producing E.coli. Compared with non- ESBL UTIs, children with ES-BL UTIs had higher heating temperature, and higher level of C- reactive protein (CRP), however, non- ESBL UTI were associat-ed with higher rate of gross hematuria (P<0.05). The curative effect of empiric therapy for non- ESBL UTIs was significantly better than ESBL UTIs (100% vs 67.80%, P=0.0015),the length of hospital stay was shorter [10 (8,13)vs 12 (9,18), P=0.0245]. Logistic regression analysis showed that the antibiotics usage before urine culture, urinary tract anomalies, fever and high level of CRP were the predictive factors of urinary tract infection caused by ESBLs- producing E.coli. Conclusion The patients with younger age (<2 years old), fever, urinary tract anomalies, high level of CRP are prone to ESBL UTIs, for whomβ- lactamase inhibitor composite antibacterial drugs or carbopenems are recommended as empiric therapy. For the patients without those factors, the third generation cephalosporin could be optional.
