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目的探讨原发性肾病综合征(PNS)并尿路感染(UTI)患儿的常见病原菌分布特点及耐药现状,并分析相关影响因素,为临床治疗提供依据。方法回顾性分析2007-2011年住院治疗的124例尿培养阳性PNS并UTI患儿的致病菌分布情况,并对常见致病菌进行药敏试验,以观察其对抗生素的敏感性,并分析PNS易并UTI的相关影响因素。结果无症状UTI的PNS患儿占70.2%。革兰阴性杆菌是PNS并UTI的主要致病菌,占61.6%,其中大肠埃希菌占43.3%;革兰阳性球菌占34.8%,其中粪肠球菌占19.5%;真菌占3.0%。大肠埃希菌对羟苄西林耐药率最高,为88.7%,而对添加了克拉维酸钾的羟氨苄西林耐药率明显降低(34.2%);在头孢菌素类抗生素中,对头孢唑林、头孢曲松、头孢噻吩的耐药率均很高(>50%),而对头孢哌酮/舒巴坦钠的耐药率明显低于其他头孢类抗生素(P<0.01);大肠埃希菌对呋喃妥因、亚胺培南的耐药率低(<10%)。粪肠球菌对利福平耐药率高(82.1%),对呋喃妥因、万古霉素、利奈唑胺耐药率低(<10%)。低清蛋白血症、低IgG血症、大量蛋白尿、大剂量糖皮质激素及低密度脂蛋白、脂蛋白(a)升高可能是导致PNS患儿易发生UTI的因素。结论 PNS患儿由于多方面因素易并UTI。无症状UTI的PNS患儿占相当高的比例。大肠埃希菌是其主要致病菌,但肠球菌感染的比例相对增高,这些致病菌耐药性高,且大部分呈多重耐药,故应对此类患儿积极行尿培养检查以指导临床用药。
Objective To investigate the distribution characteristics and drug resistance of common pathogens in children with primary nephrotic syndrome (PNS) and urinary tract infection (UTI) and to analyze the related influencing factors so as to provide the basis for clinical treatment. Methods The distribution of pathogens in 124 urinary-positive PNS-UTI children hospitalized during 2007-2011 were analyzed retrospectively. Susceptibility to common pathogenic bacteria was tested to observe their sensitivity to antibiotics and analyzed PNS and UTI related factors. Results Asymptomatic UTI accounted for 70.2% of PNS children. Gram-negative bacilli were the main pathogens of PNS and UTI, accounting for 61.6%, of which Escherichia coli accounted for 43.3%, Gram-positive cocci accounted for 34.8%, of which Enterococcus faecalis accounted for 19.5% and fungi accounted for 3.0%. Escherichia coli was the most resistant to ampicillin, which was 88.7%, while the resistance rate of ampicillin to potassium clavulanate was significantly decreased (34.2%). Among cephalosporins, The rates of resistance to cefoperazone and cefalotin were high (> 50%), while those of cefoperazone / sulbactam sodium were significantly lower than those of other cephalosporins (P <0.01) Schisandra nitrofurantoin, imipenem low resistance (<10%). Enterococcus faecalis has a high rate of rifampicin resistance (82.1%) and low (<10%) rate of nitrofurantoin, vancomycin and linezolid. Hypoproteinemia, hypoalbuminemia, massive proteinuria, high-dose glucocorticoids and low-density lipoprotein, elevated lipoprotein (a) may be the factors that cause UTI in children with PNS. Conclusion Children with PNS are prone to UTI due to many factors. Asymptomatic UTI PNS accounted for a relatively high proportion of children. Escherichia coli is the main pathogenic bacteria, but the proportion of enterococci infection is relatively high, these pathogens high resistance, and most of them were multi-drug resistance, so should actively urinary culture in such patients to guide the examination Clinical medication.