以色列南部2个月以下婴儿尿路感染后的随访：流行病学、微生物学及疾病复发特征
Follow-up after infants younger than 2 months of age with urinary tract infection in Southern Israel: epidemiologic, microbiologic and disease recurrence characteristics.
作者信息
Gurevich Evgenia, Tchernin Dov, Schreyber Ruth, Muller Robert, Leibovitz Eugene
机构信息
Pediatric Department "A", Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel; Pediatric Nephrology Clinics, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel.
Pediatric Department "A", Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel; Pediatric Emergency Medicine Department, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel.
出版信息
Braz J Infect Dis. 2016 Jan-Feb;20(1):19-25. doi: 10.1016/j.bjid.2015.09.003. Epub 2015 Nov 19.
BACKGROUND
The timing of most recurrences after neonatal urinary tract infection is during the first year of life, with peak incidence 2-6 months after the initial infection. Information on the microbiologic characteristics of recurrent urinary tract infection episodes in relation to the microbiology of the initial episodes is limited.
OBJECTIVES
To analyze the epidemiologic/microbiological characteristics of 1st and recurrent urinary tract infection in infants <2 months of age.
METHODS
A retrospective study including all infants <2 months of age with urinary tract infection admitted during 2005-2009 and followed till the age of 1 year.
RESULTS
151 neonates were enrolled (2.7% of all 5617 febrile infants <2 months of age admitted). The overall incidence of urinary tract infection occurring during the first 2 months of life was 151/73,480 (0.2%) live births during 2005-2009 in southern Israel (2.1 cases/1000 live births). One pathogen was isolated in 133 (88.1%); Escherichia coli, Klebsiella spp., Enterococcus spp., Morganella morganii, Proteus spp., and Enterobacter spp. represented the most common pathogens (57.9%, 12.2%, 7.9%, 6.7%, 6.1%, and 5%, respectively). Trimethoprim/sulfamethoxazole, ampicillin, and cefuroxime-axetil were the most commonly recommended prophylactic antibiotics (45%, 13.2%, and 8%, respectively). Twenty-three recurrent urinary tract infection episodes were recorded in 20 (13.2%) patients; 6/23 (26%) were diagnosed within one month following 1st episode. E. coli was the most frequent recurrent urinary tract infection pathogen (12/23, 52.2%). No differences were recorded in E. coli distribution between first urinary tract infection vs. recurrent urinary tract infection. Seventeen (74%) recurrent urinary tract infection episodes were caused by pathogens different (phenotypically) from those isolated in 1st episode. Recurrent urinary tract infection occurred in 25.0%, 8.3%, and 0 patients recommended trimethoprim/sulfamethoxazole, cefuroxime-axetil, or amoxicillin prophylaxis, respectively.
CONCLUSIONS
(1) The study determined the incidence of urinary tract infection in febrile infants <2 months of age in Southern Israel; (2) E. coli was responsible for the majority of first and recurrent urinary tract infection; (3) recurrent urinary tract infection was caused mostly by pathogens different than the pathogens isolated at initial episode.
背景
新生儿尿路感染后多数复发发生在出生后第一年，初次感染后2 - 6个月发病率最高。关于复发性尿路感染发作的微生物学特征与初次发作微生物学关系的信息有限。
目的
分析2个月龄以下婴儿首次及复发性尿路感染的流行病学/微生物学特征。
方法
一项回顾性研究，纳入2005 - 2009年期间收治的所有2个月龄以下尿路感染婴儿，并随访至1岁。
结果
共纳入151例新生儿（占所有5617例2个月龄以下发热婴儿的2.7%）。2005 - 2009年以色列南部活产婴儿中，出生后头2个月内尿路感染的总体发病率为151/73480（0.2%）（2.1例/1000活产）。133例（88.1%）分离出一种病原体；大肠杆菌、克雷伯菌属、肠球菌属、摩根摩根菌、变形杆菌属和肠杆菌属为最常见病原体（分别占57.9%、12.2%、7.9%、6.7%、6.1%和5%）。甲氧苄啶/磺胺甲恶唑、氨苄西林和头孢呋辛酯是最常推荐的预防性抗生素（分别占45%、13.2%和8%）。20例（13.2%）患者记录到23次复发性尿路感染发作；23次中有6次（26%）在首次发作后1个月内确诊。大肠杆菌是最常见的复发性尿路感染病原体（12/23，52.2%）。首次尿路感染与复发性尿路感染的大肠杆菌分布无差异。17次（74%）复发性尿路感染发作由（表型上）与初次发作分离出的病原体不同的病原体引起。分别接受甲氧苄啶/磺胺甲恶唑、头孢呋辛酯或阿莫西林预防的患者中，复发性尿路感染发生率分别为25.0%、8.3%和0。
结论
（1）本研究确定了以色列南部2个月龄以下发热婴儿尿路感染的发病率；（2）大肠杆菌是多数首次及复发性尿路感染的病因；（3）复发性尿路感染主要由与初次发作分离出的病原体不同的病原体引起。
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