Prevalence and treatment of urinary tract infection in children following pyeloplasty
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摘要: 目的:探讨肾盂输尿管连接部梗阻(UPJO)性肾积水患儿术后尿路感染的特点及防治策略。方法:对2010年1月~2015年12月我院收治的498例输尿管连接部(UPJ)成形术患儿术前术后均行尿常规、尿细菌培养检查,分析总结术后尿路感染率、病原体分布及药敏结果、抗生素使用情况、住院或门诊治疗率。结果:肾积水术后尿常规阳性率为71.1%,尿培养阳性率为30.1%,尿路感染率为31.7%。从150份尿培养阳性患儿尿液中共检出168份菌株,其中杆菌占80.4%,球菌占15.5%,真菌占4.2%。大肠杆菌(45.8%)、铜绿假单孢菌(13.7%)、肺炎克雷伯杆菌(9.52%)是肾积水术后尿路感染最常见的三大病原体。耐药菌感染占26.8%,机会致病菌感染占40.4%。非限制使用级抗生素使用率90.2%,限制使用级抗生素使用率为12.2%,特殊使用级抗生素使用率为13.5%。因尿路感染住院治疗率为9.64%,门诊治疗率20.9%。结论:肾积水术后尿路感染较为复杂,发生率高,耐药菌及机会致病菌感染比例高。一、二代头孢耐药率高,怀疑有感染和存在感染的高危因素应果断选用高级别抗生素。Abstract: Objective: To summarize the occurrence, pathogen distribution and antibiotics usage of urinary tract infection (UTI) following pyeloplasty in children and provide guidelines for antibiotics selection.Method: Preoperative and postoperative urinalysis and urine culture results of 498 ureteropelvic junction obstruction patients in a single center during 2010-2015 were reviewed.Incidence, pathogen distribution, drug sensitive test result and rate of antibiotics usage, inpatient and outpatient treatment (for UTI) were summarized.Result: Positive urinalysis rate was 71.1%, positive urine culture rate was 30.1%, UTI rate was 31.7%.Totally 168 bacteria strains were identified.Gram-negative bacteria accounted for 80.4%, Gram-positive bacteria accounted for 15.5% and fungi accounted for 4.2%.Escherichia coli (45.8%), Pseudomonas aeruginosa (13.7%) and Klebsiella pneumoniae (9.52%) were the three most common pathogens in UTI after pyeloplasty.Drug-resistant bacteria accounted for 26.8%, opportunistic pathogens accounted for 40.4%.The unrestricted antibiotics use rate was 90.2%, limited antibiotics use rate was 12.2%, special antibiotics use rate was 13.5%.Inpatient treatment rate of UTI after discharge was 9.64%, outpatient treatment rate was 20.9%.Conclusion: UTI following pyeloplasty is complicated, with a high incidence and percentage of drug-resistant and opportunistic pathogens.Resistance of first and second generation cephalosporin is serious, the prophylactic antibiotic usage is meaningless.When infection is suspected with multiple infection risk factors, high grade antibiotics should be selected decisively.
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