2007年上海市儿童社区获得性腹泻致病菌谱分析

Characteristics of bacterial pathogens associated with community-acquired pediatric diarrhea in Shanghai in 2007

为了解上海地区社区获得性腹泻儿童致病菌流行病学情况,对2007年度就诊于我院的2871例社区获得性腹泻患儿进行粪便弯曲菌、志贺菌、沙门菌,霍乱弧菌、副溶血性弧菌、致腹泻大肠埃希菌、气单胞菌、耶尔森菌进行培养分离、鉴定及部分菌株的血清分型。结果发现,弯曲菌在腹泻患儿粪便中的分离率为11.1%(172/1556),4月份感染率最高(P<0.001),多见于1～4岁儿童(P<0.05);其次是志贺菌,分离率为3.2%(91/2871),其中福氏志贺菌占63.7%;第3位是致腹泻大肠埃希菌,分离率为1.0%(30/2871),其中肠致病性大肠埃希菌占70.0%,以O55/K59血清型为主。沙门菌、气单胞菌分离率不超过0.5%,未检测到霍乱弧菌、副溶血性弧菌和耶尔森菌。本次调查显示,弯曲菌、志贺菌、致腹泻大肠埃希菌是目前上海地区儿童社区获得性腹泻的3种主要致病菌。弯曲菌感染率明显高于志贺菌及致腹泻大肠埃希菌,提示临床微生物室应将弯曲菌、致腹泻大肠埃希菌作为儿童社区获得性腹泻常规监测的病原微生物。

The present study was aimed to survey the prevalence of enteric bacterial pathogens associated with acute community-acquired diarrhea in children in Shanghai. Two thousand eight hundred and seventy-one （ n = 2 871 ） children with acute community-acquired diarrhea were included in this study. Bacterial pathogens were collected from stool samples and isolated by culture methods. Bacteria were identified by API system and serologic testing. The following enteric pathogens were detected ： Shigella, Escherichia coli （ E. coil ）, Salmonella, Vibrio parahaemolyticus, Vibro cholerae,Aeromonas, and Yersinia enterocolitica. The data showed that the isolation rate of Campylobacter was 11.0% （172/1 556 ） and the prevalent peak of Campylobacter was in April （P 〈 0. 001 ）. Children younger than 4 years were the most susceptible （ P 〈 0. 05 ）. The isolation rate of Shigella was 3.2% and the predominant serotype of Shigella was S. flexneri （ 63.7% ） . The isolation rate of E. coli causing diarrhea was 1.0% , among which, enteropathogenic E. coli（EPEC） accounted for 70. 0% （2t/30） and the predominant serotype of EPEC was 055/ K59. Our data indicate that Campylobacter, Shigella and E. coli causing diarrhea are the predominant pathogenic bacteria associated with community-acquired pediatric diarrhea in Shanghai in 2007. It is implied that the isolation of Campylobacter and E. coli causing intestinal diseases should be surveyed routinely.