Pape L, Gunzer F, Ziesing S, Pape A, Offner G, Ehrich J H
Abteilung für pädiatrische Nephrologie und Stoffwechselerkrankungen, Medizinische Hochschule Hannover.
Klin Padiatr. 2004 Mar-Apr;216(2):83-6. doi: 10.1055/s-2004-823143.
Epidemiology and resistance patterns of bacterial pathogens in pediatric UTI show large interregional variability and rates of bacterial resistances are changing due to different antibiotic treatment. We intended to evaluate data from northern Germany.
In 100 children (53 female, 47 male, mean age 4.4 +/- 4.2 years) with community acquired UTI, who presented in the emergency department of our medical school from 2000 - 2002, urine cultures were performed. Inclusion criteria were: acute voiding symptoms, significant bacteriuria with growth of at least 10 (5) colony-forming units/ml urine, leukocyturia > 50/ micro l. Exclusion criteria were underlying renal diseases, anatomic abnormalities of the urinary tract, age < 2 months and recurrent UTI.
Patients presented with a mean rectal temperature of 38.6 +/- 1.3 degrees C, mean CRP of 66 +/- 68 mg/dl, mean WBC 13 500 +/- 5 600/ micro l and mean urinary leukocytes of 425 +/- 363/ micro l. In urine cultures E. coli was found in 47 % of the cases, Enterococcus faecalis 23 %, Proteus mirabilis 8 %, Klebsiella oxytoca 4 %, Pseudomonas aeruginosa 5 % and others 13 %. In 76 % one and in 24 % two different bacterial species (60 % Enterococcus faecalis) were cultured. Mean resistance rates were in all bacteria (in E. coli): Ampicillin 53 % (69 %), Ampicillin and Sulbactam 51 % (61 %), Cefalosporin 1 (st) generation (Cefaclor) 48 % (24 %), Cefalosporin 2 (nd) generation (Cefuroxim) 40 % (3 %), Cefalosporin 3 (rd) generation (Cefuroxim) 33 % (0 %), Tobramycin 30 % (2 %), Ciprofloxacine 0 %, Cotrimoxazole 40 % (42 %), Nitrofurantoin 12 % (0 %).
The resistance rates to Ampicillin (+/- Sulbactam) did not increase as compared to previous analyses (1990 - 1995), however, resistance rates to Cotrimoxazole and 1 (st) generation Cefalosporines increased about 20 %. We conclude that the policies for treatment of UTI in children should be re-evaluated every 5 years according to local resistance rates.
儿童尿路感染中细菌病原体的流行病学和耐药模式存在很大的地区间差异，并且由于不同的抗生素治疗，细菌耐药率正在发生变化。我们旨在评估德国北部的数据。
2000年至2002年期间，在我校急诊科就诊的100例社区获得性尿路感染儿童（53例女性，47例男性，平均年龄4.4±4.2岁）进行了尿培养。纳入标准为：急性排尿症状、显著菌尿，尿中菌落形成单位至少为10（5）/ml、白细胞尿>50/μl。排除标准为潜在的肾脏疾病、尿路解剖异常、年龄<2个月以及复发性尿路感染。
患者的平均直肠温度为38.6±1.3℃，平均CRP为66±68mg/dl，平均白细胞计数为13500±5600/μl，平均尿白细胞为425±363/μl。尿培养中，47%的病例发现大肠埃希菌，粪肠球菌23%，奇异变形杆菌8%，产酸克雷伯菌4%，铜绿假单胞菌5%，其他13%。76%的病例培养出一种细菌，24%的病例培养出两种不同细菌（60%为粪肠球菌）。所有细菌（大肠埃希菌）的平均耐药率为：氨苄西林53%（69%），氨苄西林/舒巴坦51%（61%），第一代头孢菌素（头孢克洛）48%（24%），第二代头孢菌素（头孢呋辛）40%（3%），第三代头孢菌素（头孢曲松）33%（0%），妥布霉素30%（2%），环丙沙星0%，复方新诺明40%（42%），呋喃妥因12%（0%）。
与先前分析（1990 - 1995年）相比，氨苄西林（±舒巴坦）的耐药率没有增加，然而，复方新诺明和第一代头孢菌素的耐药率增加了约20%。我们得出结论，儿童尿路感染的治疗策略应根据当地耐药率每5年重新评估一次。
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