婴儿泌尿道感染的病原菌分布及耐药性分析

目的探讨婴儿泌尿道感染的病原菌构成及其耐药情况，以指导临床合理用药。方法对2012年5月至2013年7月某院门诊及住院婴儿送检的尿标本进行分离培养，用全自动微生物鉴定／药敏系统进行菌种鉴定和药敏试验，同时对大肠埃希菌和肺炎克雷伯菌进行超广谱β-内酰胺酶检测。结果婴儿泌尿道感染以大肠埃希菌检出率最高（46．24％），其余依次是粪肠球菌（22．04％）、肺炎克雷伯菌（7．80％）、屎肠球菌（5．37％）、铜绿假单胞菌（4．30％）。大肠埃希菌和肺炎克雷伯菌超广谱β-内酰胺酶检出率分别为46．51％和58．62％。革兰阴性菌对亚胺培南、美罗培南的耐药率为0，对氨苄西林耐药率最高（〉80％）。革兰阳性菌对万古霉素耐药率为0，对苯唑西林、妥布霉素的耐药率100％。结论婴儿泌尿道感染病原菌以大肠埃希菌为主；大肠埃希菌、肺炎克雷伯菌超广谱β-内酰胺酶检出率高，应引起重视；临床医师要根据药敏结果指导用药，对危重病例和存在泌尿道畸形反复发作病例，革兰阴性菌可选用亚胺培南、美罗培南，革兰阳性菌可选用万古霉素。

Distribution and resistance of pathogens causing urinary tract infections in infant

Objective To examine distribution and resistance of pathogens causing urinary tract infections to decide on the strategy of elinieal treatment. Methods Bacteriuria in infants from Xiamen Maternal and Children＇ s Hospital from May 2012 to July 2013 were isolated, cultured and analyzed by automated mierobiology system. Of which, Escheriehia coli and KlebsieUa pneumonia were detected by Extended-spectrum beta-lactamase （ESBL） test. Results Escherichia coli was the predominant pathogen with highest positive rate in urinary tract infections （46.24%）. The next four pathogens with higher positive rate were E. faecalis （22.04%）, Klebsiella pneumoniae （7.80%） ,Enterococcus faecium（5.37% ） and P. Aeruginosa（4.30% ）. The positive rate of ESBL test for Esehe- richia eoli and Klebsiella pneumonia were 46.51% and 58.62%, respectively. Drug sensitivity test presented that Gram-positive bacteria were sensitive to Imipenem or Meropenem but resistant to Ampicillins （ 〉 80% ） ; Gram- negative bacteria showed sensitivity to Vancomycin and resistance to Oxacillin or Tobramycine （100%）. Conclusion Escherichia eoli is the predominant pathogen causing urinary tract infections; ESBL test is effective in detecting Eseherichia coli and Klebsiella pneumoni ; Clinicians should use drugs according to result of drug sensitivity test. For severe and repeat infection cases, Imipenem and/or Meropenem could be used for Gram-positive bacterial infeetion while Vaneomycin for Gram-negative bacterial infeetion.