Analysis Of Distribution And Drug Resistance Of Pathogenic Bacteria In Urinary Tract Infections In Children

ObjectiveTo explore the distribution,changes and drug resistance of pathogens in children with urinary tract infection,so as to guide the rational and safe use of drugs in clinical practice.MethodA retrospective study was conducted on 154 children with UTI diagnosed in the Department of Nephrology,Xi’an Children’s Hospital from January 2012 to June 2020.The clinical data,laboratory and imaging examination results were analyzed to understand the distribution of children’s UTI pathogens and the changes of common pathogens,drug resistance and changes in drug resistance of common pathogens.Result1 The gender distribution of urinary tract infection children in different age groups is different,male children are more common among infants under 3 years old,and female children are more common among children over 3 years old;2 In infants with UTI often manifested as fever,urination crying symptoms;Urinary irritation is common in children over 3 years old;3 There were 74 cases(48.1 %)with risk factors in this group,and genitourinary system malformation were the most common.Recurrent urinary tract infection in children often have genitourinary system malformation,and more prone to fever.4 A total of 167 pathogens were detected in 154 children,including 107Gram-negative bacteria(64.1%),60 Gram-positive bacteria(35.9%),and 0 fungi(0%).Escherichia coli was the most common pathogen,followed by Enterococcus faecium.The distribution of pathogens in 2012-2015 and 2016-2020 was compared:the detection rate of Gram-negative bacteria no significant change,and the detection rate of Enterococcus faecium in Gram-positive bacteria increased significantly.The distribution of pathogenic bacteria in different age groups is different.Enterococcus faecium is more common in infants under 3 years old,and Escherichia coli is more common in children over 3 years old.Enterococcus faecium is commonly seen in children with genitourinary system malformation;5 The resistance rate of Escherichia coli to penicillins was 100%,and the resistance rates to some third,fourth and almost all the first and second generations of cephalosporins were more than 50%,while the resistance rates to carbapenems,piperacillin tazobactam,cefoperazone sulbactam,nitrofurantoin and cefoxitin were less than 20%.The drug resistance of Klebsiella pneumoniae is similar to that of Escherichia coli.The resistance rate of Enterococcus faecium to penicillin was more than 90%,while the resistance rate of Enterococcus faecalis to penicillin was lower than that of Enterococcus faecium.No resistant strains were found for vancomycin,teicoplanin and linezolid;6 Comparing the resistance rate changes of common pathogens,it was found that the resistance rate of Escherichia coli to gentamicin and cefoxitin increased significantly;The resistance rate of Enterococcus faecium to rifampicin increased significantly,while the resistance rate to gentamicin decreased.No significant changes were found in the resistance of Klebsiella pneumoniae.Conclusion1 UTI in children is still dominated by Escherichia coli,but it has a downward trend.Escherichia coli has low resistance to piperacillin-tazobactam and cefoperazone-sulbactam,which can be used as an empirical drug.For carbapenem-resistant strains,and severe drug resistance to cephalosporins,and antibiotics should be selected in clinical practice.2 The detection rate of Enterococcus faecium in Gram-positive cocci increased significantly,become the second pathogen of UTI in children,it is more common in children with genitourinary system malformation.Enterococcus faecium is less resistant to nitrofurantoin and it can be used as an empirical drug.3 Recurrent fever and RUTI children should actively improve imaging examination to exclude genitourinary system malformation.