志贺菌社区获得性感染、耐药及REP-PCR分型

Community acquired infection, antimicrobial resistance and REP-PCR typing of shigella

目的了解2004年夏秋季武汉市社区获得性腹泻患者中志贺菌感染、耐药及流行状况，并与2003年做比较。方法从4所大型医院门诊腹泻患者大便标本中分离培养菌株并测定药物敏感性，WHONET软件分析结果，REP-PCR进行基因分型。结果志贺菌分离率和D群比例较2003年有所上升。志贺菌对头孢他啶和头孢吡肟的敏感率为100％，氨曲南、呋喃妥因和氟喹诺酮的敏感率为93．1％～96．6％，头孢曲松、头孢噻肟、卡那霉素和庆大霉素为75．9％～82.8％。氯霉素、阿莫西林腕拉维酸、氨苄西林、萘啶酸、四环素、大观霉素和复方新诺明的敏感率均小于50％。耐药模式多达20种。REP—PCR分型结果提示D群比B群的遗传多样性高。结论志贺菌导致武汉市社区获得性腹泻的比例较低，优势血清型发生了变迁。头孢他啶、头孢吡肟、氨曲南、呋喃妥因和氟喹诺酮抗菌活性较好。B群和D群对氨苄西林、阿莫西林腕拉维酸和氯霉素的敏感性差异有显著性。REP-PCR是一种快捷有效的基因分型法。

Objective To study on the infection, antimicrobial resistance and epidemic situation of Shigella among patients with community acquired diarrhea in Wuhan during summer and autumn in 2004 and compare with the dada obtained in 2003. Methods Stains isolated from Stool samples of outpatients with diarrhea from four big hospitals were tested. WHONET was applied for analysis. REP-PCR was used for genotyping. Results The Shigellae isolate rate and the propotion of group D were higher compared with those of 2003. All the stains were susceptible to eeftazidime and cefepime; the susceptibility to aztreonam, nitrofurantoin and fluroquinolones were 93.1% --96.6% ; the susceptibility to ceftriaxone, cefetaxime, kanamycin and gentamicin were 75.9% -82.8%; chloramphenicol, amoxicillinclavulanicacid, ampicillin, nalidixic acid, tetracycline, spectinomycin and trimoxazole were lower than 50%. There were 20 kinds of resistance patterns. REP-PC;R revealed group D has more gene diversity than group B. Conclusions The rate of community acquired diarrhea caused by Shigella was low in Wuhan and the superiority serotype changed. Ceftazidime, cefepime, aztreonam, nitrofurantoin and fluroquinolones had better antimierobial activities. There were significant differences between group B and D of Shigella in the sensitivity to ampicillin, amoxicillin-clavulanic acid and chloramphenicol. REP- PCR was a valid and rapid genotyping method for homology analyzing and tracing the source of infection during epidemic outbreak.