Pouladfar Gholamreza, Basiratnia Mitra, Anvarinejad Mojtaba, Abbasi Pejman, Amirmoezi Fatemeh, Zare Samaneh
Alborzi Clinical Microbiology Research Center, Nemazee Teaching Hospital Division of Pediatric Nephrology Hematology Research Center Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
Medicine (Baltimore). 2017 Sep;96(37):e7834. doi: 10.1097/MD.0000000000007834.
Urinary tract infection (UTI) is one of the most common bacterial infections in pediatrics. Delay in diagnosis and treatment can cause significant morbidity. The physicians knowledge regarding the symptoms, microorganisms that caused UTI, and effective antibiotics in a geographical area can help them to select the appropriate antibiotics. This study was performed to determine the prevalence of bacteria that cause UTI and their susceptibility to common antibiotics as well as the common symptoms and associated factors in children of Shiraz, Southern Iran.This cross sectional study was performed among 202 children with UTI, aged 2 months to 18 years old, between August and November 2014 in pediatric medical centers of Shiraz University of Medical Sciences. Urine samples were collected using urinary catheter or suprapubic in children < 2 years and mid-stream in children over 2 years, respectively. The type of micro-organisms causing UTI was determined and evaluation of antibiotic susceptibility for each organism was assayed by the Kirby Bauer method using antibiogram test. Patient's information was collected through checking the medical documents and interview with parents.Our results showed that the frequency of UTI was significantly higher in girls (70.3%) than in boys. The most commonly discovered pathogens were Escherichia coli (E coli) (51.5%), followed by Klebsiella spp. (16.8%), and Enterococcus spp. (9.9%). Overall susceptibility test showed the highest resistance to ampicillin (81.2%) and cotrimoxazole (79.2%), and the highest sensitivity to imipenem (90.1%) and Gentamicin (65.3%). Gram negative and positive bacteria showed the highest antibiotic resistance to amoxicillin (83.8%) and clindamycin (100%), respectively. In addition, production of extended spectrum beta lactamase (ESBL) was 69.2% and 30.8% in E coli and Kelebsiella respectively.The efficacy of third generation of the cephalosporins was reduced because of the high rate of production of ESBL and drug resistance. These results inform the physician as to which antibiotics are appropriate to prescribe for the patient, as well as urine culture reports and following the patient's clinical response so that high antimicrobial resistance is not developed at the community level.
尿路感染（UTI）是儿科最常见的细菌感染之一。诊断和治疗的延迟会导致严重的发病率。医生对某一地理区域内UTI的症状、致病微生物以及有效抗生素的了解，有助于他们选择合适的抗生素。本研究旨在确定伊朗南部设拉子儿童中引起UTI的细菌的流行情况及其对常用抗生素的敏感性，以及常见症状和相关因素。
这项横断面研究于2014年8月至11月在设拉子医科大学的儿科医疗中心对202名2个月至18岁的UTI患儿进行。2岁以下儿童分别使用导尿管或耻骨上膀胱穿刺采集尿液样本，2岁以上儿童则采集中段尿。确定引起UTI的微生物类型，并采用Kirby Bauer法通过药敏试验对每种微生物的抗生素敏感性进行检测。通过查阅医疗文件和与家长访谈收集患者信息。
我们的结果显示，女孩UTI的发生率（70.3%）显著高于男孩。最常发现的病原体是大肠埃希菌（大肠杆菌）（51.5%），其次是克雷伯菌属（16.8%）和肠球菌属（9.9%）。总体药敏试验显示，对氨苄西林（81.2%）和复方新诺明（79.2%）的耐药性最高，对亚胺培南（90.1%）和庆大霉素（65.3%）的敏感性最高。革兰阴性菌和革兰阳性菌分别对阿莫西林（83.8%）和克林霉素（100%）表现出最高的抗生素耐药性。此外，大肠杆菌和克雷伯菌中产超广谱β-内酰胺酶（ESBL）的比例分别为69.2%和30.8%。
由于ESBL的高产生率和耐药性，第三代头孢菌素的疗效降低。这些结果告知医生为患者开哪种抗生素合适，以及尿液培养报告和跟踪患者的临床反应，以便在社区层面不会产生高抗菌耐药性。
