摘要
目的了解上海市松江地区腹泻病例的病原谱和流行病学特征,初步构建"区级疾控中心-监测哨点医院"区域性腹泻病综合监测网。方法根据上海市腹泻病监测实施方案,2017-2019年间隔抽取区内2家监测点医院,对其肠道门诊腹泻病例进行调查采样,同时进行11种病原菌分离鉴定和8种病毒核酸检测,对检测阳性的部分副溶血性弧菌、致泻性大肠埃希菌、沙门菌进行头孢西丁、头孢噻肟等11种抗生素耐药性监测。结果 3年共报告急性初诊腹泻病例5 766例,采样753份,阳性检出率为40.11%,细菌、病毒及混合感染阳性检出率分别为20.05%、18.99%和1.06%,≥2种病原混合感染阳性率检出率为3.72%。共检出332株病原体,包括9种细菌、6种病毒,主要为诺如病毒90株(占27.11%)和副溶血性弧菌60株(占18.07%)。病原检出率呈较明显的夏季和秋冬季高峰,病毒和细菌检出率整体呈现交替互补的特点。细菌检测高峰为2017年8-10月,2018年8-9月和2019年5-9月;病毒检出高峰为2017年2-4月、2018年12月-2019年4月、2019年11-12月,同期细菌和病毒阳性检出率差异均有统计学意义(P值均<0.01)。感染人群主要集中在20~39岁年龄组(占57.61%)。副溶血性弧菌和致泻大肠埃希菌对环丙沙星、诺氟沙星、左氧氟沙星、庆大霉素高度敏感、沙门菌对氯霉素高度敏感(均为100.0%),3种细菌对其他抗生素均有不同程度耐药。结论松江地区腹泻病原谱较为广泛,高发季节是夏季和秋冬季,主要病原构成是副溶血弧菌、弯曲菌、致泻性大肠埃希菌、沙门菌以及诺如病毒和轮状病毒。副溶血性弧菌、致泻性大肠埃希菌、沙门菌对常见抗生素有不同程度耐药。初步构建了"区级疾控中心-监测哨点医院"腹泻综合监测网络。
Objective To investigate the pathogen spectrum distribution and prevalence characteristics of diarrhea in Songjiang district of Shanghai city;to establish an initial regional comprehensive surveillance network of Songjiang District Center for Disease Control and Prevention-sentinel hospitals for diarrheal diseases.Methods According to diarrheal disease surveillance implementation plan in Shanghai,diarrhea cases in intestinal outpatient departments of 2 sentinel hospitals according to a certain sampling interval in Songjiang district from 2017 to 2019,whose stool samples were collected for bacteriological and virological detections for 11 kinds of pathogenic bacteria and 8 kinds of virus at the same time.The drug resistance of 11 kinds of antibiotics such as cefoxitin and cefotaxime was monitored for some positive strains of Vibrio parahaemolyticus,diarrhoeal Escherichia coli and Salmonella.Results A total of 5766 cases of diarrhea were monitored in 2 sentinel hospitals in the 3-year period,a total of 753 stool samples were collected for detection,resulting positive detection rate of 40.11%.The positive rates of bacteria,virus and mixed infection were 20.05%,18.99% and1.06%,respectively.The positive rate of mixed infection with multiple pathogens was 3.72%.A total of 332 strains of pathogens were identified,including 9 kinds of bacteria and 6 kinds of virus,mainly were Norovirus(90 strains,accounted for 27.11%)and Vibrio parahaemolyticus(60 strains,accounted for 18.07%).The positive rates of pathogens peaked obviously in summer and autumn-winter seasons,the overall positive rate of virus and bacteria showed alternating complementation characteristics.The peaks of bacteria and virus detection were Aug-Oct in 2017,Aug-Sep in 2018,May-Sep in 2019 and Feb-Apr in 2017,Dec in 2018-Aprin 2019,Nov-Dec in2019;respectively.The difference between positive detection rates of bacteria and virus in the same period were statistically significant(all P<0.01).The infected population mainly concentrated in the age group of 20-39 years(accounted for 57.61%).Vibrio parahaemolyticus and Diarrheal Escherichia coli had the highest susceptibility(100.0%)to ciprofloxacin,norfloxacin,levofloxacin and gentamicin.Salmonella had the highest susceptibility(100.0%)to chloramphenicol;all three kinds of bacteria showed certain degrees of drug resistance to other antibiotics.Conclusion The diarrhea pathogen spectrum was relatively broard in Songjiang district and prevalent season of acute infectious diarrhea disease are summer and autumn-winter seasonsV.ibrio parahaemolyticus,campylobacter,Diarrheal Escherichia coli and Salmonella were the main bacteria pathogens while Norovirus and Rotavirus were the main virus pathogens.Vibrio parahaemolyticus,Diarrheal Escherichia coli and Salmonella showed different degrees of resistance to common antibiotics.A regional comprehensive surveillance network for diarrheal diseases has been initially established.
作者
杨丽华
俞佳莉
盛峰松
乔雪飞
陆利君
刘玲
钱懿青
鞠卫华
张清慧
黄丽
YANG Li-hua;YU Jia-li;SHENG Feng-song;QIAO Xue-fei;LU Li-jun;LIU Ling;QIAN Yi-qing;JU Wei-hua;ZHANG Qing-hui;HUANG Li(Songjiang District Center for Disease Control and Prevention,Shanghai 201620,China)
出处
《江苏预防医学》
CAS
2021年第1期17-20,25,共5页
Jiangsu Journal of Preventive Medicine
基金
上海市卫生和计划生育委员会面上项目(201840144)。
关键词
腹泻病
监测
病原谱
流行病学特征
耐药
Diarrheal diseases
Surveillance pathogen spectrum
Epidemiological characteristics
Antimicrobial resistance
作者简介
并列第一作者:杨丽华(1969-),女,上海市人,主任技师,研究方向:病原微生物检验;并列第一作者:俞佳莉(1992-),女,上海市人,检验技师,研究方向:病原微生物检验。
