Clinical And Etiological Analysis Of Primary Nephrotic Syndrome Complicated With Urinary Tract Infection In Children

Objective:To analyze the clinical features,etiological distribution and drug sensitivity of PNS complicated with UTI in children,and to provide a reference for diagnosis of UTI and the use of antibiotics.Methods:Study the clinical and etiological characteristics of 221patients who hospitalized in the Children’s Hospital affiliated to Chongqing Medical University from January 2008 to December 2017 retrospectively with SPSS 19.0 software.Results:Preschool with PNS are prone to UTI,and the sex ratio was no significant difference in different age groups(?~2=3.671,p=0.055).The incidence of UTI in recurrent PNS is higher than that in initial PNS(?~2=83.20,p<0.05).The clinical manifestation mainly presented with asymptomatic bacteria(78.28%).The proportion of recurrent PNS and the use ofcorticosteroidmedications and/or immunosuppressantin asymptomatic UTI group were significantly higher than those in symptomatic UTI group(all p<0.05).The incidence recurrent UTI was13.12%.Compared with the initial UTI,recurrent UTI has longer course,and significantly higher proportion of relapsed PNS,decreased Hb and C3and urinary system malformation(all p<0.05).Gram-negative bacteria were the dominant pathogens,and Escherichia coli was the main bacteria.Compared the distribution of pathogens in different age groups,the proportion of gram-negative bacteria decreased while the gram-positive bacteria increased with age,but there was no significant difference(all p?0.05).There was no significant difference in the distribution of UTI among different age groups(all p?0.05).There was no significant difference in pathogenic distribution between asymptomatic UTI group and symptomatic UTI group(all p?0.05).The proportion of Escherichia coli,Pseudomonas aeruginosa and ESBLs producing bacteria were significantly higher in recurrent UTI group than those in initial UTI group(all p<0.05).The drug sensitivity test indicated that gram-negative bacteria were more sensitive to amikacin,meropenem,and piperacillin/tazobactam,and gram-positive bacteria were more sensitive to vancomycin,linazolamine and teicoplanin.The drug resistance of Escherichia coli to cefotaxime in recurrent UTI group and initial UTI group was significantly different(p<0.05).While the drug resistances of other common gram-positive pathogens in two groups were not significantly different(all p?0.05).Conclusion:Preschool with PNS and relapsed PNS are prone to UTI.UTI in PNS mainly presented with asymptomatic bacteria.PNS relapse in children who have stopped corticosteroid medications or who are undergoing corticosteroid and/or immunosuppressive therapy should be considered UTI.PNS with longer course,anemia,decreased complement,and urinary system malformation may be more likely to develop recurrent UTI.Gram-negative bacteria are the dominant pathogens.Escherichia coli is the main bacteria with high drug resistance and ESBLs producing bacteria may be more common in recurrent UTI.Piperacillin/tazobactam could be the first choice of empirical antimicrobial agents for PNS complicated with UTI.