儿科尿路感染的细菌耐药模式变化及经验性抗生素治疗的原理。
Changes in Bacterial Resistance Patterns of Pediatric Urinary Tract Infections and Rationale for Empirical Antibiotic Therapy.
机构信息
Department of Pediatrics, Division of Pediatric Nephrology, Marmara University School of Medicine, İstanbul, Turkey.
出版信息
Balkan Med J. 2017 Sep 29;34(5):432-435. doi: 10.4274/balkanmedj.2015.1809. Epub 2017 Apr 6.
BACKGROUND
The causative agent spectrum and resistance patterns of urinary tract infections in children are affected by many factors.
AIMS
To demonstrate antibiotic resistance in urinary tract infections and changing ratio in antibiotic resistance by years.
STUDY DESIGN
Retrospective cross-sectional study.
METHODS
We analysed antibiotic resistance patterns of isolated Gram (-) bacteria during the years 2011-2014 (study period 2) in children with urinary tract infections. We compared these findings with data collected in the same centre in 2001-2003 (study period 1).
RESULTS
Four hundred and sixty-five uncomplicated community-acquired Gram (-) urinary tract infections were analysed from 2001-2003 and 400 from 2011-2014. Sixty-one percent of patients were female (1.5 girls : 1 boy). The mean age of children included in the study was 3 years and 9 months. Escherichia coli was the predominant bacteria isolated during both periods of the study (60% in study period 1 and 73% in study period 2). Bacteria other than E. coli demonstrated a higher level of resistance to all of the antimicrobials except trimethoprim-sulfamethoxazole than E. coli bacteria during the years 2011-2014. In our study, we found increasing resistance trends of urinary pathogens for cefixime (from 1% to 15%, p<0.05), amikacin (from 0% to 4%, p<0.05) and ciprofloxacin (from 0% to 3%, p<0.05) between the two periods. Urinary pathogens showed a decreasing trend for nitrofurantoin (from 17% to 7%, p=0.0001). No significant trends were detected for ampicillin (from 69% to 71%), amoxicillin-clavulanate (from 44% to 43%), cefazolin (from 39% to 32%), trimethoprim-sulfamethoxazole (from 32% to 31%), cefuroxime (from 21% to 18%) and ceftriaxone (from 10% to 14%) between the two periods (p>0.05).
CONCLUSION
In childhood urinary tract infections, antibiotic resistance should be evaluated periodically and empiric antimicrobial therapy should be decided according to antibiotic sensitivity results.
背景
儿童尿路感染的病原体谱和耐药模式受多种因素影响。
目的
展示尿路感染的抗生素耐药性，并按年份显示抗生素耐药性的变化比例。
研究设计
回顾性横断面研究。
方法
我们分析了 2011 年至 2014 年（研究期 2）儿童尿路感染中分离的革兰氏阴性菌的抗生素耐药模式。我们将这些发现与同一中心 2001 年至 2003 年（研究期 1）收集的数据进行了比较。
结果
分析了 2001 年至 2003 年的 465 例单纯性社区获得性革兰氏阴性尿路感染和 2011 年至 2014 年的 400 例。61%的患者为女性（1.5 名女孩：1 名男孩）。纳入研究的儿童平均年龄为 3 岁 9 个月。研究期间，大肠杆菌均为主要分离菌（研究期 1 为 60%，研究期 2 为 73%）。除复方磺胺甲噁唑外，其他细菌对所有抗菌药物的耐药性均高于大肠杆菌，2011 年至 2014 年间，除复方磺胺甲噁唑外，其他细菌对所有抗菌药物的耐药性均高于大肠杆菌。在我们的研究中，我们发现尿路感染病原体对头孢克肟（从 1%到 15%，p<0.05）、阿米卡星（从 0%到 4%，p<0.05）和环丙沙星（从 0%到 3%，p<0.05）的耐药性呈上升趋势。尿路感染病原体对呋喃妥因的耐药性呈下降趋势（从 17%到 7%，p=0.0001）。氨苄西林（从 69%到 71%）、阿莫西林克拉维酸（从 44%到 43%）、头孢唑林（从 39%到 32%）、复方磺胺甲噁唑（从 32%到 31%）、头孢呋辛（从 21%到 18%）和头孢曲松（从 10%到 14%）的耐药性在两个研究期间均无显著变化趋势（p>0.05）。
结论
在儿童尿路感染中，应定期评估抗生素耐药性，并根据抗生素药敏结果决定经验性抗菌治疗。
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