摘要
目的分析开封地区细菌性痢疾患儿的临床表现、流行病学特征、病原菌及耐药率。方法选取2019-2021年开封市儿童医院小儿内科就诊的腹泻患儿,其中232例被确诊为细菌性痢疾。制定病历调查表,采用一对一方式,收集患儿资料(包括基础资料、临床表现、病原菌及耐药性),分析细菌性痢疾患儿的临床表现及流行病学特点。参与本次研究的所有患儿,进行抗菌治疗前,采集患儿新鲜粪便标本。接种于培养基进行培养,挑取菌落进行病原菌鉴定及血清凝集试验。采用K-B纸片扩散法,进行志贺菌属对氨苄西林、氨苄西林/舒巴坦、头孢他啶、头孢曲松、头孢吡肟、亚胺培南、美罗培南、环丙沙星、左氧氟沙星及复方新诺明的药敏试验。结果232例细菌性痢疾患儿的临床表现中,腹痛、呕吐、阵发性哭闹、每日腹泻次数>10次、每日腹泻次数≤10次、低热、中热、高热、黄色稀水样便、黄色糊状便、黏液脓血便的发生率分别为100%、70.26%、75.86%、33.19%、66.81%、42.24%、31.03%、26.72%、27.59%、11.21%和61.21%。其中腹痛、阵发性哭闹、呕吐,居临床表现前3位。按照患儿发病年龄分组,<1岁组12例,1~岁组42例,3~岁组60例,5~岁组37例,7~岁组33例,9~岁组28例,11~岁组20例。232例细菌性痢疾患儿,2019年85例,2020年77例,2021年70例。每年1月份的发病率最低,分别为1.18%、1.30%和1.43%。发病率逐月上升,每年7月份为高发期,分别为20.00%、19.48%和21.43%。8月份开始发病率逐月下降,12月份的分别为2.35%、2.60%和2.86%。共检出病原菌216株,阳性率93.10%。2019年检出85株,2020年70株,2021年61株,阳性率分别为100%、90.91%和87.14%,患儿粪便标本病原菌阳性率呈现逐年下降趋势。检出福氏志贺菌137株,各年度分别检出61、43和33株,检出率逐年下降。检出宋内志贺菌60株,各年度分别检出19、20和21株,检出率逐年上升。检出鲍氏志贺菌14株,各年度分别检出4、5和5株,检出率逐年上升。检出痢疾志贺菌5株,各年度分别检出1、2和2株,检出率逐年上升。216株志贺菌属对氨苄西林、氨苄西林/舒巴坦、头孢他啶、头孢曲松、头孢吡肟、亚胺培南、美罗培南、环丙沙星、左氧氟沙星及复方新诺明的药敏试验显示,各年度均未产生亚胺培南、美罗培南的耐药株。对氨苄西林、氨苄西林/舒巴坦、复方新诺明的耐药率较高,各年度均高于50%,并呈现逐年升高的趋势。对头孢他啶、头孢吡肟的耐药率较低,各年度均低于50%。头孢曲松的耐药率,各年度分别为40.00%、45.71%和54.10%,呈现快速上升的变化趋势。结论开封地区小儿细菌性痢疾,发病患儿主要集中于3-5岁,高发于每年7月份。以福氏志贺菌为主要病原菌,对多种抗菌药物的耐药性逐年上升,药物敏感性发生变化,临床上应重点关注本地区志贺菌属亚型及耐药情况。
Objective To analyze the clinical manifestations,epidemiological characteristics,pathogenic bacteria and drug resistance rate of children with bacillary dysentery in Kaifeng.Methods From January 2019 to December 2021,232 children with diarrhea were selected from the Pediatric Department of Kaifeng Children's Hospital.A medical record questionnaire was developed to collect children's data(including basic data,clinical manifestations,pathogens and drug resistance)in a one-to-one manner,and analyze the clinical manifestations and epidemiological characteristics of children with bacillary dysentery.All children participating in this study should collect fresh stool samples before antibacterial treatment.Inoculate in the culture medium for culture,select the colony for pathogen identification and serum agglutination test.The drug sensitivity testes of Shigella to ampicillin,ampicillin/sulbactam,cef tazidime,ceftriaxone,cefepime,imipenem,meropenem,ciprofloxacin,levofloxacin and compound sulfamethoxazole were carried out by the K-B disk diffusion method.Results Among the clinical manifestations of 232 children with bacterial dysentery,the incidence rates of abdominal pain,vomiting,paroxysmal crying,daily diarrhea>10 times,daily diarrhea≤10 times,low fever,moderate fever,high fever,yellow watery stool,yellow pasty stool,mucopurulent stool were 100%,70.26%,75.86%,33.19%,66.81%,42.24%,31.03%,26.72%,27.59%,11.21%,61.21%,respectively.Among them,abdominal pain,paroxysmal crying and vomiting were the top three clinical manifestations.According to the age of onset of the children,there were 12 cases in the<1 year old group,42 cases in the 1-year old group,60 cases in the 3-year old group,37 cases in the 5-year old group,33 cases in the 7-year old group,28 cases in the 9-year old group,and 20 cases in the 11-year old group.There were 232 children with bacterial dysentery.According to the year of onset,there were 85 children in 2019,77 children in 2020 and 70 children in 2021.The lowest incidence rate is in January every year,with the percentages of 1.18%,1.30%and 1.43%respectively.The incidence rate increases month by month,and the high incidence period is in July every year,with the percentages of 20.00%,19.48%and 21.43%respectively.Since August,the incidence rate has declined month by month,and the percentages in December were 2.35%,2.60%and 2.86%respectively.216 strains of pathogenic bacteria were detected,with a positive rate of 93.10%.A total of 85 pathogens were detected in 2019,70 pathogens were detected in 2020,and 61 pathogens were detected in 2021,with positive rates of 100%,90.91%,and 87.14%respectively.The positive rate of pathogens in stool samples of children showed a downward trend year by year.A total of 137 strains of S.fle.xneri were detected,61 strains,43 strains and 33 strains were detected respectively in three years,and the detection rate decreased year by year.A total of 60 strains of S.sonnei were detected,19,20 and 21 strains were detected respectively in three years,and the detection rate increased year by year.A total of 14 strains of S.baumannii were detected,and 4,5 and 5 strains were detected respectively in three years,with the detection rate increasing year by year.A total of 5 strains of S.dysenteriae were detected,and 1,2 and 2 strains were detected respectively in three years,with the detection rate increasing year by year.The drug susceptibility test of 216 strains of Shigella to ampicillin,ampicillin/sulbactam,ceftazidime,ceftriaxone,cefepime,imipenem,meropenem,ciprofloxacin,levofloxacin and compound sulfamethoxazole showed that there were no resistant strains of imipenem and meropenem from 2019 to 2021.The drug resistance rate to ampicillin,ampicillin/sulbactam and cotrimoxazole was relatively high,higher than 50%from 2019 to 2021,and showed an increasing trend year by year.The drug resistance rate to ceftazidime and cefepime is low,which will be less than 50%in 20192021.The drug resistance rate of ceftriaxone from 2019 to 2021 was 40.00%,45.71%and 54.10%respectively,showing a trend of rapid increase.Conclusion In Kaifeng area,children with bacillary dysentery are mainly 3 to 5 years old,and the incidence is high in July every year.With S.flexneri as the main pathogen,the resistance to a variety of antibacterial drugs has increased year by year,and drug sensitivity has changed.In clinical practice,we should focus on the subtypes and drug resistance of S.flexneri in this region.
作者
李九英
李平真
邱亚明
张翠
LI Jiu-ying;LI Ping-zhen;QIU Ya-ming;ZHANG Cui(Kaifeng Children’s Hospital of Henan Province,Kaifeng 475000,Henan,China;Huaihe Hospital of Henan University)
出处
《中国病原生物学杂志》
CSCD
北大核心
2023年第3期327-331,共5页
Journal of Pathogen Biology
关键词
细菌性痢疾
志贺菌
耐药性
bacterial dysentery
shigella
drug resistance
作者简介
通讯作者:李九英(1976-),女,河南西华人,医学硕士,副主任医师,主要从事消化内科感染性疾病、胃肠道过敏症,内镜下治疗等。E-mail:457841882@qq.com
