463例腹泻患者病原微生物监测结果分析

Monitoring and analysis of pathogenic microorganisms in 463 patients with diarrhea

目的了解463例腹泻患者粪样病原微生物分离情况,指导临床治疗。方法收集463例腹泻患者临床资料和粪便标本,检测细菌和病毒。病毒检测采用实时荧光定量反转录-聚合酶链反应检测核酸,细菌鉴定采用全自动微生物鉴定仪鉴定菌株。结果 463例腹泻患者标本分离病原菌91株,分离率19.65%。29株细菌包括致泻性大肠埃希菌11株,副溶血性弧菌7株,空肠弯曲菌5株,沙门菌3株,志贺氏菌3株;62株病毒包括诺如病毒34株,轮状病毒15株,札如病毒6株,星状病毒4株,肠道腺病毒3株。2015、2016、2017年分离病原菌26、34和31株,分离率18.71%、19.88%和20.26%;春季、夏季、秋季、冬季腹泻患者分离病原菌13、64、8和6株,分离率为12.50%、29.49%、9.76%和10.00%;12~岁、15~岁、45~岁、≥60岁患者分离病原菌54、5、9和23株,分离率分别为27.27%、10.00%、11.39%和16.91%;腹泻频率3~6次/d的患者289例(62.42%)、排泄水样粪便患者341例(73.65%)、排泄稀软粪便患者72例(15.55%);腹痛患者252例(54.43%),主要表现为阵发性腹痛,腹痛部位主要为脐周;呕吐症状的患者90例(19.44%),呕吐频率以1~3次/d居多;恶心患者119例(25.70%),发热患者48例(10.37%)。结论腹泻患者以病毒感染为主,病原菌以诺如病毒和致泻性大肠埃希菌居多。临床治疗中,应格外重视夏季发病患者,特别是青少年患者,并结合其临床症状给予基础病症判断。

Objective To analyze the prevalence of pathogenic microorganisms in 463 patients with diarrhea in order to guide clinical treatment. Methods Clinical data on and stool specimens from 463 patients were collected to detect bacteria and viruses.Viruses were detected using a real-time fluorescence quantitative reverse transcription polymerase chain reaction,and bacteria were identified using an automated microbial identification system.Results were statistically analyzed. Results Ninety-one strains of pathogens were isolated from samples from 463 patients with diarrhea（19.65% of samples）.Twenty-nine strains of bacteria were isolated,including 11 strains of diarrheagenic Escherichia coli,7 strains of Vibrio parahaemolyticus,5 strains of Campylobacter jejuni,3 strains of Salmonella,and 3 strains of Shigella.Sixty-two strains of viruses were isolated,including 34 strains of Norovirus,15 strains of Rotavirus,6 strains of Sapovirus,4 strains of Astrovirus,and 3 strains of enteric adenovirus.Twenty-six strains（18.71%）of pathogens were isolated in2015,34（19.88%）were isolated in 2016,and 31（20.26%）were isolated in 2017.Thirteen strains（12.50%）of pathogens were isolated from patients with diarrhea in the spring,64（29.49%）were isolated in the summer,8（9.76%）were isolated in the autumn,and 6（10.00%）were isolated in the winter.Fifty-four strains（27.27%）of pathogens were isolated from patients ages 12-14 with diarrhea,5（10.00%）were isolated from those ages 15-44,9（11.39%）were isolated from those ages 45-59,and 23（16.91%）were isolated from those age≥60.Two hundred and eight-nine patients（62.42%）had diarrhea 3-6 times/d,341（73.65%）had watery stools,and 72（15.55%）had loose stools.Two hundred and fifty-two patients（54.43%）had abdominal pain.Abdominal pain primarily manifested as paroxysmal abdominal pain,and abdominal pain was mainly located in the umbilical region.Ninety patients（19.44%）vomited at a frequency of1-3 times/d,119（25.70%）had nausea,and 48（10.37%）had a fever. Conclusion The pathogens infecting patients with diarrhea were mainly diarrheagenic E.coli and Norovirus.Diarrhea was mainly caused by a viral infection.When clinically treating diarrhea,emphasis should be placed on treating patients in the summer,and especially adolescent patients.Diarrhea and other clinical symptoms can provide a basis for identifying an underlying condition.