1996—2005年我院儿童细菌性痢疾的临床流行病学

Clinical epidemiology of Shigellosis in children from 1996 to 2005

目的了解近10年我院诊治的儿童细菌性痢疾(菌痢)的流行特征及临床变迁。方法对1996-2005年我院诊治的粪便培养为志贺菌而确诊为菌痢的2541例患儿(323例为住院患儿)作回顾性分析,统计分析采用卡方检验。结果近10年菌痢呈全年散发,每年6-11月为流行季节。1～6岁儿童为高发人群。323例住院病例中临床分型以普通型为主,占88.24%,轻型为4.64%,中毒型为7.12%。福氏菌仍为主要的流行菌群,其次为宋氏菌,但2000年起,宋氏菌有上升趋势。近10年,志贺菌对头孢曲松及氨苄西林-舒巴坦的耐药率有所上升,而对氯霉素及复方磺胺甲噁唑的耐药率有所下降。结论目前我院收治儿童菌痢呈散发,志贺菌对儿童常用的第三代头孢菌素耐药率上升,故应合理选择有效抗生素,减少使用抗生素频率。

Objective To investigate the clinical epidemiology of Shigellosis in children during recent 10 years. Methods A retrospective analysis was conducted in 2 541 children patient with Shigellosis from 1996 to 2005. Chi-square test was used for statistical analysis. Results There were sporadic cases of children Shigellosis in Shanghai area. Most cases occurred in summer and autumn （from June to November）. The prevalence was higher in children of 1- 6 years old. The clinical features of most cases belonged to ＂common type＂ （88.24%）, followed by mild type （4.64%） and toxic type （7. 12% ）. The result of bacterial typing revealed that S. flexneri was the primary epidemic pathogen, followed by S. sonnei. The prevalence of S. sonnei has risen since 2000. In recent 10 years, the resistance of Shigella to ceftriaxone and ampicillin ＋ sulbactam has increased. The resistance to chloramphenicol and SMZ-TMP has decreased. Conclusions Shigellosis in children is mainly sporadic in Shanghai area. The resistance of Shigella to the third generation cephalosporins has risen. We should use the effective antibiotics and avoid antibiotic misuse.