Clinical analysis of 468 children with urinary tract infection
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摘要:目的 分析不同年龄段小儿泌尿道感染的临床特点、致病菌分布及影像学检查情况。方法 选取468例泌尿道感染患儿为研究对象，将其分为婴儿组（1个月~1岁）、幼儿组（>1~3岁）及儿童组（>3岁），分析3组的临床资料。结果 小儿泌尿道感染以婴幼儿多见，婴儿组中以发热为首发症状的患儿比率为52.15%，高于幼儿组（17.27%）及儿童组（5.23%），差异有统计学意义（P < 0.05）；儿童组中尿路刺激征患儿比率为63.37%，高于婴儿组（8.60%）及幼儿组（41.82%），差异有统计学意义（P < 0.05）；婴儿组中合并泌尿系发育异常者比率为32.80%，与幼儿组（21.82%）及儿童组（17.44%）比较，差异有统计学意义（P < 0.05）。468例患儿中段尿培养检出病原菌共105例（22.43%），其中革兰阴性菌71例（67.62%），以大肠埃希菌为主；革兰阳性菌31例（29.52%），其中以屎肠球菌为主。结论 婴儿泌尿道感染患儿以男童多见，临床症状缺乏特异性，多以发热为临床表现，局部症状不明显，应注意尿常规检查。随着年龄的增长，女童泌尿道感染比率逐渐升高，临床以尿路刺激症状为主要表现的患儿比率也逐渐上升。泌尿道感染的病原菌仍以革兰阴性菌为主，大肠埃希菌占比最高，而革兰阳性菌中屎肠球菌的检出率也相对较高。Abstract:Objective To analyze the clinical features, pathogens distribution and imaging examination conditions in children with urinary tract infection (UTI).Methods A total of 468 UTI patients were selected, and were divided into infant group (1 month to 1 year old), toddler group (above 1 year to 3 years old) and children group (above 3 years old). Clinical data of the three groups were analyzed.Results Urinary tract infection in children was more common in infants. In the infant group, the rate of children with fever as the first symptom was 52.15%, which was significantly higher than that in the infant group (17.27%) and the children group (5.23%) (P < 0.05). The rate of urinary tract irritation in children group was 63.37%, which was significantly higher than that in the infant group (8.60%) and the toddler group (41.82%) (P < 0.05). The rate of abnormal development of urinary tract in the infant group was 32.80%, which showed statistically significant difference compared with that in the toddler group (21.82%) and the children group (17.44%) (P < 0.05). In addition, 105(22.43%) were detected pathogens in 468 patients, including 71 cases with Gram-negative bacteria (67.62%), with Escherichia coli ranking first, and 31 with Gram-positive bacteria (29.52%), with Enterococcus faecium accounting for the most.Conclusion Infant urinary tract infection is more common in boys, and the clinical symptoms are lack of specificity. Most of the clinical manifestations are fever, and local symptoms are not obvious, so routine urine detection should be paid attention. With the increase of age, the rate of urinary tract infection in girls is gradually increasing, and the rate of children with urinary tract irritationas the main clinical manifestation is also gradually increasing. Escherichia coli is still a common pathogen in children with UTI. The main pathogenic bacteria of urinary tract infection were Gram-negative bacilli, Escherichia coli accounted for the highest proportion, and the detection rate of Enterococcus faecium among Gram-positive bacteria is also relatively high.
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Keywords:
- urinary tract infection /
- children /
- clinical features /
- pathogenic bacteria
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表 1 泌尿系畸形患儿泌尿道彩超检查结果
泌尿道畸形 n 比率/% 左肾积水 32 27.83 左肾积水伴左输尿管扩张 31 26.96 右肾集合系统分离 16 13.91 双肾积水 4 3.48 双肾积水伴输尿管扩张 9 7.83 右肾积水 3 2.61 右肾积水伴右输尿管扩张 6 5.22 左肾盂扩张伴输尿管重复畸形 1 0.86 左侧重复肾 2 1.74 右侧巨输尿管 4 3.48 后尿道瓣膜 3 2.61 右肾发育不良 2 1.74 右肾盂输尿管梗阻 1 0.86 多囊肾 1 0.86 
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表 2 3组UTI彩超检查合并泌尿系发育异常患儿情况[n(%)]
组别 合并泌尿系发育异常 无泌尿系发育异常 婴儿组(n=186) 61(32.80) 125(67.20) 幼儿组(n=110) 24(21.82)* 86(78.18) 儿童组(n=172) 30(17.44)* 142(82.56) 与婴儿组比较, * P＜0.05。
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表 3 468例UTI患儿病原菌阳性检出情况
病原菌 n 比率/% 革兰阴性菌 71 67.62 大肠埃希菌 47 44.76 肺炎克雷伯菌 9 8.57 铜绿假单胞菌 7 6.67 奇异变形杆菌 1 0.95 嗜麦芽窄食单胞菌 3 2.86 棒状杆菌 2 1.90 产气肠杆菌 2 1.90 革兰阳性球菌 31 29.52 屎肠球菌 21 20.00 粪肠球菌 9 8.57 棉子糖肠球菌 1 0.95 真菌 3 2.86 白假丝酵母菌 3 2.86
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