2021年北京市哨点医院致泻大肠埃希氏菌感染病例特征分析

Analysis on characteristics of diarrhea caused by Diarrheagenic Escherichia coli infection in Beijing Sentinel Hospital,2021

目的 通过分析2021年北京市哨点医院致泻大肠埃希氏菌(Diarrheagenic Escherichia coli,DEC)感染病例的流行趋势和临床特征,为制定有效的健康教育与疾病防控提供依据。方法 收集2021年北京市36家食源性疾病主动监测医院腹泻病例的粪便或肛拭子标本及其性别、年龄、住址、发病时间、饮食史、临床特征等信息,对采集的粪便或肛拭子标本中的DEC进行分离培养鉴定。采用χ^(2)或Fisher确切概率法检验比较DEC不同分型的阳性检出率。结果 2021年北京市食源性疾病监测共采集腹泻病例粪便或肛拭子标本5697份,DEC阳性检出率为7.65%(436/5697),其中20~39岁年龄组阳性检出率最高(χ^(2)=18.804,P<0.001)。从年龄分布来看,20~39岁年龄组肠产毒性大肠埃希菌(Enterotoxigenic Escherichia coli,ETEC)阳性病例数高于其他年龄组(χ^(2)=36.769,P<0.001),从地区分布来看,感染肠聚集性大肠埃希菌(Enteroaggregative Escherichia coli,EAEC)和肠致病性大肠埃希菌(Enteropathogenic Escherichia coli,EPEC)的病例多来自远郊(χ^(2)=50.679,χ^(2)=19.659,P均<0.001),感染ETEC的病例主要分布在城区(χ^(2)=13.420,P=0.001)。从季节分布来看,EAEC、ETEC和EPEC夏季感染均高于其他季节(χ^(2)=32.096,χ^(2)=89.339,χ^(2)=16.876,P均<0.001),肠出血性大肠埃希菌(Enterohemorrhagic Escherichia coli,EHEC)感染主要发生在春季(χ^(2)=10.976,P<0.001)。自述可疑饮食史信息方面,感染ETEC的病例多食用过酒类及冷冻食品(χ^(2)=41.837,P<0.001),EAEC感染者多食用过婴儿食品(χ^(2)=24.229,P=0.007)。临床特征方面,出现腹痛的病例ETEC检出率更高(χ^(2)=8.017,P=0.005),出现恶心或呕吐的病例中EAEC的检出率更高(χ^(2)=5.701,P=0.017;χ^(2)=4.160,P=0.041)。结论 北京市哨点医院致泻大肠埃希氏菌感染病例具有季节性及人群流行特征,可结合不同分型DEC感染病例的可疑食品暴露信息及临床特征,为食品安全健康宣教和临床诊断提供依据。

Objective To analyze the epidemiological and clinical characteristics of diarrhea cases infected by Diarrheagenic Escherichia coli(DEC)in Beijing Sentinel Hospital in 2021,and to provide a basis for effective disease prevention and control.Methods Fecal or anal swab samples of diarrhea cases were collected from 36 active monitoring hospitals for foodborne diseases in Beijing in 2021.The information included gender,age,address,onset time,personal basic information,dietary history,and clinical characteristics were also collected.DEC in the collected fecal or anal swab samples were isolated,cultured,and identified.Adoptχ^(2) or Fisher′s exact probability test were used to compare the positive detection rates of different subtypes of DEC.Results In 2021,5697 stool or anal swab samples of diarrhea cases were collected from Foodborne illness surveillance in Beijing.The positive detection rate of DEC was 7.65%(436/5697),with the high⁃est positive detection rate in the group aged 20-39(χ^(2)=18.804,P<0.001).From the perspective of age distribution,ETEC positive cases in group aged 20-39 were higher than those in other age groups(χ^(2)=36.769,P<0.001).Based on regional distribution,most cases of EAEC and EPEC infections came from the suburbs(χ^(2)=50.679,χ^(2)=19.659,P<0.001),cases of ETEC infection were mainly distributed in urban areas(χ^(2)=13.420,P=0.001).From a seasonal distri⁃bution perspective,EAEC,ETEC,and EPEC infections occurred more frequently in summer than in other seasons(χ^(2)=32.096,χ^(2)=89.339,χ^(2)=16.876,P<0.001),EHEC infection mainly occurred in spring(χ^(2)=10.976,P<0.001).In terms of suspected dietary history characteristics,cases of ETEC infection often consumed packaged drinking water,alcohol,beverages,and frozen foods(χ^(2)=41.837,P<0.001),EAEC infected people had taken more Baby food(χ^(2)=24.229,P=0.007).In terms of clinical characteristics,cases with abdominal pain had a higher detection rate of ETEC(χ^(2)=8.017,P=0.005),the detection rate of EAEC was higher in cases with nausea or vomiting(χ^(2)=5.701,P=0.017;χ^(2)=4.160,P=0.041).Conclusion The cases of diarrhea caused by DEC infection in Beijing Sentinel Hospital have seasonal and population epidemiological characteristics,which can be combined with suspected food exposure information and clinical characteristics of different subtypes of DEC infection cases to provide a basis for food safety and health education and clinical diagnosis.