Zhou Guanglun,Sun Junjie,Yin Jianchun,et al.Analysis of pathogens and clinical features of neuropathic bladder with urinary tract infection in children[J].Journal of Clinical Pediatric Surgery,2021,20(11):1021-1025.[doi:10.12260/lcxewkzz.2021.11.005]
儿童神经源性膀胱并尿路感染的临床特点及病原菌分析
- Title:
- Analysis of pathogens and clinical features of neuropathic bladder with urinary tract infection in children
- Keywords:
- Neurogenic Bladder; Urinary Tract Infection; Bacteria; Fungi; Child
- 分类号:
- R726.945;R378;R379
- 摘要:
- 目的 探讨儿童神经源性膀胱并尿路感染的临床特点、病原菌分布与病原菌耐药性，为临床诊治提供依据。方法 收集2010年1月至2019年12月深圳市儿童医院泌尿外科收治的神经源性膀胱并尿路感染患者的临床资料（包括临床表现、合并畸形、尿培养结果、病原菌耐药监测、抗生素选择等），并进行回顾性分析。结果 本研究共纳入33例研究对象，其中男17例，女16例。年龄1~156个月。28例反复尿路感染（感染次数≥3次），其中1例感染达8次。临床表现以发热为主，大龄儿童主要表现为尿频、尿痛和腹痛。33例因尿路感染住院93次，培养出87株菌株，其中革兰氏阴性菌63株、革兰氏阳性菌17株、真菌7株。63株革兰氏阴性菌中，大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌对氨苄西林、头孢呋辛钠的耐药率≥78%，对哌拉西林/他唑巴坦及美罗培南的敏感率≥88.9%。经哌拉西林/他唑巴坦抗感染治愈33例；经头孢呋辛钠治疗无效，根据药敏试验结果改用哌拉西林/他唑巴坦治愈13例。结论 神经源性膀胱患者反复尿路感染发生率高。致病菌以革兰氏阴性杆菌为主。革兰氏阴性菌对青霉素、头孢类抗生素耐药性高。哌拉西林/他唑巴坦及碳青霉烯类对病原菌敏感性高，哌拉西林/他唑巴坦抗感染治疗效果显著。
- Abstract:
- Objective To assess the clinical features, pathogenic distributions and drug resistance of neuropathic bladder with urinary tract infection in children so as to provide rationales for clinical diagnosis and treatment of the disease. Methods From January 2010 to December 2019, clinical data were retrospectively reviewed for 33 hospitalized children of neuropathic bladder with urinary tract infection. Results There were 17 boys and 16 girls with an age range of 1-156 months. Repeated infections thrice and more occurred in 28 cases. One case had 8 bouts of infection. Fever was the most common. Elder children had frequent & painful urination and abdominal pain. A total of 87 strains were cultured from the samples from 33 children, including 63 strains of Gram-negative bacteria and 17 strains of Gram-positive bacteria. The drug resistant rates of Gram-negative bacteria to ampicillin and cefuroxime sodium were both >78%. The sensitive rates to piperacillin tazobactam and meropenem were >88%. Thirty-three cases were cured by piperacillin tazobactam and another 13 cases cured by switching cefuroxime sodium to piperacillin tazobactam. Conclusion Clinical manifestations of neuropathic bladder with urinary tract infection are non-typical and repeated infections occur frequently. The resistance rate to penicillin or cephalosporins is high. The drug resistance rate of piperacillin tazobactam is low with a decent prognosis.
参考文献/References:
1 王朝旭, 张潍平.小儿神经源性膀胱药物治疗及现状[J].中华实用儿科临床杂志, 2017, 32(23):1833-1835.DOI:10.3760/cma.j.issn.2095-428X.2017.23.022. Wang CX, Zhang WP.Current status of drug treatment for neurogenic bladder in children[J].Chin J Appl Clin Pediatr, 2017, 32(23):1833-1835.DOI:10.3760/cma.j.issn.2095-428X.2017.23.022.
2 Hoen L, Ecclestone H, Blok BFM, et al. Long-term effectiveness and complication rates of bladder augmentation in patients with neurogenic bladder dysfunction:A systematic review(Review)[J].Neurourol Urodyn, 2017, 36(7):1685-1702.DOI:10.1002/nau.23205.
3 Nseyo U, Santiago-Lastra Y.Long-term complications of the neurogenic bladder[J].Urol Clin North Am, 2017, 44(3):355-366.DOI:10.1016/j.ucl.2017.04.003.
4 Rosen JM, Kriegermeier A, Adams PN, et al. Urinary tract infection in infancy is a risk factor for chronic abdominal pain in childhood[J].J Pediatr Gastroenterol Nutr, 2015, 60(2):214-216.DOI:10.1016/S0016-5085(14)63262-5.
5 Gomila A, Carratalà J, Eliakim-Raz N, et al. Risk factors and prognosis of complicated urinary tract infections caused by Pseudomonas aeruginosa in hospitalized patients:a retrospective multicenter cohort study[J]. Infect Drug Resist, 2018, 11:2571-2581.DOI:10.2147/IDR.S185753.
6 周广伦, 尹鉴淳, 徐万华, 等. 儿童复杂性上尿路感染68例临床特点[J].中华实用儿科临床杂志, 2017, 32(5):358-360.DOI:10.3760/cma.j.issn.2095-428X.2017.05.010. Zhou GL, Yin JC, Xu WH, et al. Analysis of clinical features of 68 cases of complicated upper urinary tract infection in children[J].Chin J Appl Clin Pediatr, 2017, 32(5):358-360.DOI:10.3760/cma.j.issn.2095-428X.2017.05.010.
7 呼和, 蒋飞, 姬广春, 等. 光修复对脊髓栓系伴神经源性膀胱大鼠的作用研究[J].临床小儿外科杂志, 2020, 19(7):648-652.DOI:10.3969/j.issn.1671-6353.2020.07.017. Hu H, Jiang F, Ji GC, et al. Effect of light repair on spinal cord tether with neurogenic bladder in rats[J].J Clin Ped Sur, 2020, 19(7):648-652.DOI:10.3969/j.issn.1671-6353.2020.07.017.
8 Manosuthi W, Wiboonchutikul S.Treatment outcomes of oral sitafloxacin in acute complicated urinary tract infection and pyelonephritis[J].SpringerPlus, 2016, 5:410.DOI:10.1186/s40064-016-2044-5.
9 杨仁国, 王蜀强, 龙姗姗, 等. 复杂性尿路感染243例病原菌构成及药敏分析[J].中国抗生素杂志, 2017, 42(12):1050-1055.DOI:10.3969/j.issn.1001-8689.2017.12.006. Yang GQ, Wang SQ, Long SS, et al. Analysis of pathogens and drug resistances in 243 cases with complicated urinary tract infections[J].Chin J Antibio, 2017, 42(12):1050-1055.DOI:10.3969/j.issn.1001-8689.2017.12.006.
10 Koningstein M, van der Bij AK, de Kraker ME, et al. Recommendations for the empirical treatment of complicated urinary tract infections using surveillance data on antimicrobial resistance in the Netherlands[J].PLoS One, 2014, 9(1):e86634.DOI:10.1371/journal.pone.0086634.
11 Ahmed MN, Vannoy D, Frederick A, et al. First-line antimicrobial resistance patterns ofescherichia coli in children with urinary tract infection in emergency department and primary care clinics[J].Clin Pediatr (Phila), 2016, 55(1):19-28.DOI:10.1177/0009922815588822.
12 Mendes RE, Flamm RK, Hogan PA, et al. Summary of linezolid activity and resistance mechanisms detected during the 2012 LEADER surveillance program for the United States[J].Antimicrob Agents Chemother, 2014, 58(2):1243-1247.DOI:10.1128/aac.02112-13.
13 杨青, 俞云松, 林洁, 等. 2005-2014年CHINET肠球菌属细菌耐药性监测[J].中国感染与化疗杂志, 2016, 16(2):146-152.DOI:CNKI:SUN:KGHL.0.2016-02-008. Yang Q, Yun YS, Lin J, et al. Resistance profile of Enterococcus in hospitals across China:results of CHINET Antimicrobial Resistance Surveillance Program, 2005-2014[J].Chin J Infect Chemother, 2016, 16(2):146-152.DOI:CNKI:SUN:KGHL.0.2016-02-008.
14 Wang J, He L, Sha J, et al. Etiology and antimicrobial resistance patterns in pediatric urinary tract infection[J].Pediatr Int, 2018, 60(5):418-422.DOI:10.1111/ped.13526.
15 孙涛, 贾洪涛, 王秀新, 等. 复杂性尿路感染的病原菌分布及革兰阴性杆菌的耐药性分析[J].国际泌尿系统杂志, 2018, 38(2):237-240.DOI:10.3760/cma.j.issn.1673-4416.2018.02.018. Sun T, Jian HT, Wang XX, et al. Distribution of pathogens in complicated urinary tract infection and drug resistance of Gram-negative bacteria[J].International Journal of Urology and Nephrology, 2018, 38(2):237-240.DOI:10.3760/cma.j.issn.1673-4416.2018.02.018.
16 Albin OR, Patel TS, Kaye KS.Meropenem-vaborbactam for adults with complicated urinary tract and other invasive infections[J].Expert Rev Anti Infect Ther, 2018, 16(12):865-876.DOI:10.1080/14787210.2018.1542300.
17 Shim BS, Kim CS, Kim ME, et al. Antimicrobial resistance in community-acquired urinary tract infections:results from the Korean Antimicrobial Resistance Monitoring System[J].J Infect Chemother, 2011, 17(3):440-446.DOI:10.1007/s10156-010-0178-x.
相似文献/References:
[1]杨兴欢,陈燕,蒲青崧,等.儿童神经源性膀胱患者上尿路受损的危险因素及其预测价值研究[J].临床小儿外科杂志,2021,20(11):1005.[doi:10.12260/lcxewkzz.2021.11.002]
Yang Xinghuan,Chen Yan,Pu Qingsong,et al.Risk factors and predictors of upper urinary tract damage in pediatric neurogenic bladder[J].Journal of Clinical Pediatric Surgery,2021,20(11):1005.[doi:10.12260/lcxewkzz.2021.11.002]
[2]刘晓东,李守林,姜俊海,等.小儿神经源性膀胱保守治疗期间伴发慢性肾病的相关因素分析[J].临床小儿外科杂志,2021,20(11):1011.[doi:10.12260/lcxewkzz.2021.11.003]
Liu Xiaodong,Li Shoulin,Jiang Junhai,et al.Analysis of causes of chronic kidney disease associated with conservative treatment of neurogenic bladder in children[J].Journal of Clinical Pediatric Surgery,2021,20(11):1011.[doi:10.12260/lcxewkzz.2021.11.003]
[3]张志远,钟量,邹翔宇,等.骶神经调控对学龄前期神经源性膀胱患者尿动力学参数的影响[J].临床小儿外科杂志,2021,20(11):1016.[doi:10.12260/lcxewkzz.2021.11.004]
Zhang Zhiyuan,Zhong Liang,Zou Xiangyu,et al.Effect of sacral neuromodulation on urodynamic parameters in preschool children with neurogenic bladder[J].Journal of Clinical Pediatric Surgery,2021,20(11):1016.[doi:10.12260/lcxewkzz.2021.11.004]
[4]王冰蕊,张谦,李骥,等.膀胱扩容术联合输尿管再植术治疗神经源性膀胱的效果分析[J].临床小儿外科杂志,2022,21(10):968.[doi:10.3760/cma.j.cn101785-202201019-012]
Wang Bingrui,Zhang Qian,Li Ji,et al.Analysis of augmentation cystoplasty plus ureter reimplantation for children with neurogenic bladder[J].Journal of Clinical Pediatric Surgery,2022,21(11):968.[doi:10.3760/cma.j.cn101785-202201019-012]
[5]杨屹,刘鑫.关于儿童膀胱输尿管反流治疗中的几个焦点问题[J].临床小儿外科杂志,2023,22(10):901.[doi:10.3760/cma.j.cn101785-202302027-001]
Yang Yi,Liu Xin.Several focal issues in the treatment of vesicoureteral reflux in children[J].Journal of Clinical Pediatric Surgery,2023,22(11):901.[doi:10.3760/cma.j.cn101785-202302027-001]
[6]刘鑫,刘舸,杨屹.儿童原发性膀胱输尿管反流突破性尿路感染的风险因素分析[J].临床小儿外科杂志,2023,22(10):911.[doi:10.3760/cma.j.cn101785-202307033-003]
Liu Xin,Liu Ge,Yang Yi.Related factors predicting breakthrough febrile urinary tract infection in children with vesicoureteral reflux[J].Journal of Clinical Pediatric Surgery,2023,22(11):911.[doi:10.3760/cma.j.cn101785-202307033-003]
[7]孙婕,孙宁,张潍平,等.输尿管远端直径比对儿童原发性膀胱输尿管反流早期突破性尿路感染的预测作用研究[J].临床小儿外科杂志,2023,22(10):917.[doi:10.3760/cma.j.cn101785-202305019-004]
Sun Jie,Sun Ning,Zhang Weiping,et al.Role of distal ureteral diameter ratio in predicting early breakthrough urinary tract infections in children with primary vesicoureteral reflux[J].Journal of Clinical Pediatric Surgery,2023,22(11):917.[doi:10.3760/cma.j.cn101785-202305019-004]
[8]孙小刚,王若义.儿童神经源性膀胱手术治疗进展[J].临床小儿外科杂志,2023,22(10):992.[doi:10.3760/cma.j.cn101785-202108051-017]
Sun Xiaogang,Wang Ruoyi.Recent advances of surgery for children with neurogenic bladder[J].Journal of Clinical Pediatric Surgery,2023,22(11):992.[doi:10.3760/cma.j.cn101785-202108051-017]
备注/Memo
收稿日期:2020-11-24。
基金项目:国家自然科学基金（编号：U1904208）
通讯作者:李守林,Email:lishoulinsz@126.com