摘要
目的对昆明市儿童医院感染性腹泻沙门菌和志贺菌的分布和药敏结果进行分析,为临床合理用药提供参考依据。方法收集2017年1月至2020年12月门诊及住院腹泻患儿的粪便标本进行沙门菌和志贺菌培养,病原菌用全自动细菌分析仪VITEK COMPACT培养鉴定及药敏,并进行血清凝集分型,最后用WHONET 5.6软件对原始数据进行统计学处理。结果在检测的29674份标本中,分离出志贺菌属和沙门菌属共226株,志贺菌属75株(33.2%),福氏志贺菌33株(14.6%),宋内志贺菌42株(18.6%),未检出痢疾志贺菌和鲍氏志贺菌。分离出沙门菌属151株(66.8%),共检测出5种血清型,其中鼠伤寒沙门菌106株(46.9%),伤寒沙门菌25株(11.1%)。腹泻患儿主要分布在4~10月,聚集分布在5~10月。2岁以下是沙门菌感染的易感人群,占72.8%(110/151)。沙门菌属感染引起的腹泻呈逐年上升趋势,沙门菌以鼠伤寒沙门菌为主。志贺菌在2017年、2018年以福氏志贺菌为主,而2019年以后转变为宋内志贺菌为主。另外,药敏结果显示沙门菌儿童感染性腹泻临床首选药物为阿莫西林/克拉维酸(敏感率82%),而宋内志贺菌首选药物为头孢他啶(敏感率97.6%)和阿莫西林/克拉维酸(敏感率92.8%),福氏志贺菌对头孢他啶、头孢吡肟敏感率仅为60%和40%,提示志贺菌属各血清群对抗菌药物敏感性不同,差异有统计学意义(P均<0.05)。沙门菌属和志贺菌属均为未发现亚胺培南耐药菌株。结论沙门菌和志贺菌引起的儿童感染性腹泻以沙门菌为主,呈逐年上升趋势,以2岁以下高发,鼠伤寒沙门菌为主要血清型,经验性用药首选阿莫西林/克拉维酸。各血清型志贺菌对抗菌药物的耐药性有所不同。需加强腹泻儿童粪便的病原菌和耐药监测,以便临床医生根据药敏结果给予针对性抗感染治疗。
Objective To study the distribution and drug sensitivity of Salmonella and Shigella in bacterial infectious diarrhea in children in Kunming and provide reliable basis for clinical rational drug use.Methods Salmonella and Shigella were cultured from the fecal samples of children with diarrhea in Kunming children’s Hospital from 2017 to 2020.The pathogens were identified by Vitek compact,an automatic bacterial analyzer,and their drug sensitivity was determined.The agglutination serotyping was completed.Finally,the original data were analyzed and statistically analyzed by WHONET 5.6 software.Results A total of 226 strains of Shigella and Salmonella were isolated from 29674 specimen in our hospital from 2017 to 2020,including 75 strains of Shigella(33.2%),33 strains of Shigella flexneri(14.6%),42 strains of Shigella sonnei(18.6%),and no Shigella dysentery and Shigella baumannii were detected.151 strains(66.8%)of Salmonella were isolated and 5 serotypes were detected,including 106 strains(46.9%)of Salmonella typhimurium and 25 strains(11.1%)of Salmonella typhimurium.The main distribution of infectious diarrhea in Kunming children is from April to October,and the aggregation distribution is from May to October.72.8%(110/151)of the population under 2 years old were susceptible to Salmonella infection.Diarrhea caused by Salmonella infection in children in Kunming is increasing year by year,and Salmonella typhimurium is the main Salmonella.This study showed that Shigella flexneri was the main Shigella species in 2017 and 2018,and changed to Shigella sonnei after 2019.In addition,amoxicillin/clavulanic acid(82%)was the first choice for children with infectious diarrhea caused by Salmonella in Kunming,while ceftazidime(97.6%)and amoxicillin/clavulanic acid(92.8%)were the first choice for Shigella sonnei.The sensitivity rates of Shigella flexneri to ceftazidime and cefepime were only 60%and 40%,which suggested that the susceptibility of Shigella serogroups to antibiotics is different.No imipenem resistance was found in Sal
作者
黄海林
李小娟
尹建雯
蒋鸿超
HUANG Hai-lin;LI Xiao-juan;YIN Jian-wen;JIANG Hong-chao(Dept.of Clinical Laboratory,Kunming Children’s Hospital,Kunming Yunnan,650228;Center for Disease Control of Yunnan Province,Kunming Yunnan 650118,China)
出处
《昆明医科大学学报》
CAS
2021年第7期83-87,共5页
Journal of Kunming Medical University
基金
云南省中青年学术和技术带头人项目(202005AC160066)
昆明市春城人才计划青年拔尖专项基金资助项目(C201914013)。
关键词
儿童
感染性腹泻
病原菌
耐药率
Children
Infectious diarrhea
Pathogens
Drug resistance rate
