CAJ | 학술논문

目的研究儿童铜绿假单胞菌(PA)引起的社区获得性尿路感染(CAUTIs)的特征,分析其危险因素和对抗生素的敏感情况,为PA-CAUTIs的诊断和治疗提供参考依据.方法收集22例PA-CAUTIs患儿临床资料、实验数据和影像学特点,并与同一时期随机选择54例大肠埃希菌(Escherichia coli,E.coli)引起的CAUTIs进行对比.结果 22例PA-CAUTIs中白蛋白水平均值为(32.25±13.81) mg/ml、19例有住院史、6例有尿路手术史、7例长期使用糖皮质激素或免疫抑制剂、20例有基础疾病.与E.coli-CAUTIs进行比较,PA-CAUTIs患者的白蛋白水平更低(P=0.017),有住院史(P=0.03)、尿路手术史(P=0.03)、长期使用糖皮质激素或免疫抑制剂(P =0.044)史的比例更高.对单因素分析有统计学意义的变量(有住院史、长期使用糖皮质激素或免疫抑制剂、白蛋白值、有基础疾病、尿路手术史)进行多因素Logistic回归分析发现,有基础疾病(OR值8.500,95％ CI1.513 ～47.761,P=0.037)和尿路手术史(OR值6.196,95％ CI 1.120～ 34.273,P=0.037)是PA-CAUTIs的独立危险因素.PA菌株对哌拉西林、氨曲南、庆大霉素的耐药率都为36.36％,对头孢吡肟、头孢他定的耐药率为31.82％,对碳青霉烯类抗生素的耐药率(4.55％)相对较低,只对多黏菌素为全部敏感.结论有基础疾病和尿路手术史是PA-CAUTIs发生的独立危险因素,碳青霉烯类抗生素和多黏菌素可考虑为其治疗的首选药物.
목적 연구인동동록가단포균(PA)인기적사구획득성뇨로감염(CAUTIs)적특정,분석기위험인소화대항생소적민감정황,위PA-CAUTIs적진단화치료제공삼고의거.방법 수집22례PA-CAUTIs환인림상자료、실험수거화영상학특점,병여동일시기수궤선택54례대장애희균(Escherichia coli,E.coli)인기적CAUTIs진행대비.결과 22례PA-CAUTIs중백단백수평균치위(32.25±13.81) mg/ml、19례유주원사、6례유뇨로수술사、7례장기사용당피질격소혹면역억제제、20례유기출질병.여E.coli-CAUTIs진행비교,PA-CAUTIs환자적백단백수평경저(P=0.017),유주원사(P=0.03)、뇨로수술사(P=0.03)、장기사용당피질격소혹면역억제제(P =0.044)사적비례경고.대단인소분석유통계학의의적변량(유주원사、장기사용당피질격소혹면역억제제、백단백치、유기출질병、뇨로수술사)진행다인소Logistic회귀분석발현,유기출질병(OR치8.500,95％ CI1.513 ～47.761,P=0.037)화뇨로수술사(OR치6.196,95％ CI 1.120～ 34.273,P=0.037)시PA-CAUTIs적독립위험인소.PA균주대고랍서림、안곡남、경대매소적내약솔도위36.36％,대두포필우、두포타정적내약솔위31.82％,대탄청매희류항생소적내약솔(4.55％)상대교저,지대다점균소위전부민감.결론 유기출질병화뇨로수술사시PA-CAUTIs발생적독립위험인소,탄청매희류항생소화다점균소가고필위기치료적수선약물.
Objective To study the characteristics of community-acquired urinary tract infections (CAUTIs) in children,analyze the risk factors and the susceptibility of antibiotics,thus to provide references to the diagnosis and medication of Pseudomonas aeruginosa (PA)-CAUTIs.Mothod Totally 22 cases of PA-CAUTIs were selected in one hospital from Jan,2006 to Jan,2012,their clinical information,laboratory results and radiological images were collected,and were compared with the CAUTIs cased by E.coli of those randomly selected over the same period.Result In those 22 cases with PA-CAUTIs,the mean value of protein level was (32.25 ± 13.81) mg/ml,19 of them were hospitalized,6 had urinary operation history,7 of them had long-term usage of glucocorticoids or immunosuppressive agents,and 20 had underlying diseases.A total of 22 children with 26 PA-CAUTIs episodes were compared to E.coli-CAUTIs.Compared with E.coli-CAUTls patients,children with PA-CAUTIs more often presented with a lower albumin (P =0.017),a history of urinary operation (P =0.03),more cases had a history of urinary operation (P =0.03),a long-term usage of glucocorticoids or immunosuppressive medication (P =0.044).Through multivariate logistic regression of variables that were significant in univariate analysis (with hospitalizations,long-term usage of glucocorticoids or immunosuppressive,albumin,underlying disease and urinary operation histories),and it turned out that underlying diseases (odds ratio 8.500,95％ CI 1.513-47.761,P =0.037) and with urinary operation histories (odds ratio 6.196,95％ CI 1.120-34.273,P =0.037) were proved as the independent risk factors for PA-CAUTIs.Those PA bacterial strains had a 36.36％ resistance rate to piperacillin,aztreonam and gentamicin,a 31.82％ resistance rate to cefepimeand ceftazidime,while the resistance rate (4.55％) to carbapenem antibiotics was relatively low,only to bacillosporin all the strains were sensitive.Conclusion Underlying diseases and the urinary operation histories are the independent risk factors of the occurrence of PA-CAUTIs,carbapenem antibiotics and bacillosporin can be considered as the drugs of choice for its treatment.