Zhan Zhuqin, Liao Jianying, Lin Xiaoliang, Li Guangbo, Su Dequan, Zeng Jinhua, Shen Qian
Department of Nephrology, Children's Hospital of Fudan University (Xiamen Branch), Xiamen Children's Hospital, Xiamen, People's Republic of China.
Department of Respiratory, Children's Hospital of Fudan University Xiamen Branch (Xiamen Children's Hospital), Xiamen, People's Republic of China.
Infect Drug Resist. 2025 Sep 3;18:4677-4688. doi: 10.2147/IDR.S537033. eCollection 2025.
To analyze the distribution of pathogens and drug resistance in children with urinary tract infections (UTIs) in a single center in Xiamen and to guide the selection of empirical antibiotics in the clinic.
Clinical data of 2001 children with UTIs in Xiamen Children's Hospital between 2014 and 2022 were retrospectively analyzed, grouped by age and comorbidities. Differences in pathogen distribution and drug sensitivity were compared with the chi-square test applied and significance set at p < 0.05.
Of 2001 urine samples collected, 965 (42.73%) had positive results for common infections. Gram-negative bacteria predominated (644/965; 66.74%), with Escherichia coli being the most prevalent (432/965; 44.77%). The top five pathogens were Escherichia coli, Enterococcus faecalis, Klebsiella pneumoniae, Enterococcus faecalis, Pseudomonas aeruginosa. The percentage of Escherichia coli was higher in simple UTIs than complex (54.01% vs 45.35%), and Pseudomonas aeruginosa (9.59% vs 2.74%) and fungi (7.27% vs 1.96%) were higher in complex UTIs (p < 0.05). Predominance of Pseudomonas aeruginosa and Enterococcus faecalis in boys and Enterococcus faecalis in girls. Escherichia coli had a significantly lower rate of resistance to ampicillin than Klebsiella pneumoniae (p < 0.001), and both had a high rate of resistance to cephalosporins (over 95% to cefazolin), but a low rate of resistance to amikacin and furotoxin. Pseudomonas aeruginosa had 100% resistance to most cephalosporins, but less than 7% to ceftazidime, cefepime and piperacillin tazobactam. Enterococcus faecalis had over 90% resistance to Ampicillin, Penicillin, Linezolid and 91.53% to tetracycline. No Tigecycline/Vancomycin-resistant enterococci were found. Both Gram-negative and Gram-positive bacteria maintained relatively low rates of resistance to Nitrofurantoin.
Pediatric UTIs in Xiamen show gender-based pathogen differences, mainly gram-negative. Nitrofurantoin is preferred for mild cases, and the clinical selection should be individualized by combining the regional pathogen spectrum and drug sensitivity.
分析厦门某单中心儿童尿路感染（UTIs）的病原菌分布及耐药情况，以指导临床经验性抗生素的选择。
回顾性分析2014年至2022年期间厦门儿童医院2001例UTIs患儿的临床资料，按年龄和合并症进行分组。应用卡方检验比较病原菌分布及药敏差异，设定p < 0.05为有统计学意义。
在收集的2001份尿液样本中，965份（42.73%）常见感染检测结果为阳性。革兰阴性菌占主导（644/965；66.74%），其中大肠埃希菌最为常见（432/965；44.77%）。前五位病原菌为大肠埃希菌、粪肠球菌、肺炎克雷伯菌、粪肠球菌、铜绿假单胞菌。单纯性UTIs中大肠埃希菌的比例高于复杂性UTIs（54.01%对45.35%），而复杂性UTIs中铜绿假单胞菌（9.59%对2.74%）和真菌（7.27%对1.96%）的比例更高（p < 0.05）。男孩中以铜绿假单胞菌和粪肠球菌为主，女孩中以粪肠球菌为主。大肠埃希菌对氨苄西林的耐药率显著低于肺炎克雷伯菌（p < 0.001），两者对头孢菌素的耐药率均较高（对头孢唑林超过95%），但对阿米卡星和呋喃妥因的耐药率较低。铜绿假单胞菌对大多数头孢菌素的耐药率为100%，但对头孢他啶、头孢吡肟和哌拉西林他唑巴坦的耐药率低于7%。粪肠球菌对氨苄西林、青霉素、利奈唑胺的耐药率超过90%，对四环素的耐药率为91.53%。未发现耐替加环素/万古霉素的肠球菌。革兰阴性菌和革兰阳性菌对呋喃妥因的耐药率均相对较低。
厦门儿童UTIs存在基于性别的病原菌差异，主要为革兰阴性菌。轻症病例首选呋喃妥因，临床选择应结合地区病原菌谱和药敏进行个体化。
