摘要
目的监测杭州市儿童细菌性感染性腹泻常见肠道病原菌(志贺菌和沙门菌)的构成、变迁及药敏情况,为杭州市儿童感染性腹泻的流行病学研究及临床合理用药提供依据。方法对门诊及住院腹泻患儿的粪便标本进行志贺菌和沙门菌培养,病原菌经生化和血清学鉴定到种、群,纸片扩散法测定抗菌药物的敏感性。结果 2008-2012年分离出志贺菌和沙门菌共281株,其中志贺菌属119株,占42.3%(包括B群福氏志贺菌82株、C群鲍氏志贺菌6株、D群宋内志贺菌31株),以B群和D群为主(分别占29.2%和11.0%),B/D比值为2.64∶1,未检出痢疾志贺菌;沙门菌属162株,占57.6%,并呈逐年上升趋势。患儿男女性别比约为1.38∶1。儿童感染性腹泻主要分布在5-10月,集聚分布在7-8月。对各菌属的耐药分析表明,志贺菌和沙门菌对抗菌药物的耐药率有差异,志贺菌属耐药率普遍比沙门菌属高;头孢噻肟、头孢曲松、氨苄西林/舒巴坦、复方新诺明耐药率均高;头孢他啶、氨苄西林、头孢吡肟、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦耐药率较低,未发现亚胺培南耐药菌株。结论近几年杭州市儿童沙门菌属感染引起腹泻呈逐年上升趋势,志贺菌属仍以福氏志贺菌为主。志贺菌和沙门菌引起的儿童感染性腹泻治疗首选抗生素哌拉西林/他唑巴坦,其次为头孢他啶和头孢吡肟。
Objective To understand the epidemiological and etiological characteristics of infectious diarrhea caused by Salmonella and ShigeUa in children and pathogens＇ drug resistance in Hangzhou, Zhejiang province and provide evidence for the related research and rational use of antibiotics. Methods Salmonella and Shigella were cultured by using the stool samples collected from the diarrheal children hospitalized or seeking medical care in our hospital. The isolated strains were identified by biochemical and serological tests, and disk diffusion method was used to test the drug susceptibility of these strains. Results A total of 281 pathogenic strains were isolated from 2008 to 2012, including 119 Shigella strains （42.3%） and 162 Salmonella strains （57.6%）. In 119 Shigella strains, 82 were S. flexneri strains （29. 2% ） ,31 were S. sonnei strains （ 11.0% ） and 6 were S. boydii strains （2.1%）. S. flexneri and S. sonnei strains were predominated with the ratio of 2.64： I. No S. dysenteriae was detected. The proportion of Salmonella strains detected increased year by year. The male to female ratio of the cases was 1.38： 1. Infectious diarrhea mainly occurred from May to October, but the incidence peak was during July-August. The drug resistance of Shigella and Salmonella were different. The drug resistant rate of Shigella was higher than that of Salmonella. The results of drug susceptibility test in vitro showed the resistant rates of ShigeUa and Salmonella to cefotaxime, ceftriaxone, ampicillin/sulbactam and SMZ-TMP were higher than those to ceftazidime, ampicillin, cefepime, cefoperazone/sulbactam and piperacillin/ tazobactam. No resistance to imipenem was detected. Conclusion In recent years, the incidence of diarrhea caused by Salmonella in children increased in Hangzhou. S. flexneri was also the major pathogen to cause bacteria diarrhea in children. PiperaciUin/tazobactam, ceftazidime and cefepime, are usually used to treat infectious diarrhea caused by ShigeUa and Salmonella in children.
出处
《疾病监测》
CAS
2014年第5期364-368,共5页
Disease Surveillance
关键词
儿童、感染性腹泻
病原菌
耐药率
Children, Infectious diarrhea
Pathogenic bacteria
Drug resistance
作者简介
厉小玉，女，浙江省人，副主任技师，主要从事微生物检验及医院感染监测工作
通信作者：赵仕勇，Tel：0571—85463970，Email：jhzsyhj@163．com
