2009年北京地区儿童感染性腹泻病原学及耐药性分析

Analysis of etiology and drug resistance of infectious diarrhea among children in Beijing area in 2009

目的研究北京地区儿童急性感染性腹泻的病原学变化、流行病学特征及耐药性变迁情况。方法对2009年1月～10月肠道门诊疑诊为细菌性腹泻病者便标本做细菌培养和血清分型鉴定，药敏试验采用纸片扩散法，以免疫层析双抗体夹心法定性检测A群轮状病毒抗原。结果256份标本检出病原菌4种87株（有1份便标本同时检出2种菌），检出率为34．0％。男女检出比为1．69：1，2岁以下患儿55例（64．0％）。沙门菌40株（46．0％），志贺菌23株（26．4％），致泻性大肠杆菌2株（2．3％），金黄色葡萄球菌22株（25．3％）。志贺菌中D群13株（56．5％），22株金黄色葡萄球菌有20株发生于〈1岁婴儿。沙门菌和志贺菌的耐药率分别为：氨苄西林（65．0％；95．7％）、复方新诺明（20．0％；78．3％）、环丙沙星（7．5％；8．7％）、头孢曲松（15．0％；73．9％）。256份标本中A群轮状病毒检测阳性47份，其中同时便培养阳性者13份。结论2009年北京地区儿童细菌性腹泻的病原菌以非伤寒沙门菌为主，志贺菌以D群为主要流行株，二者的易感人群以2岁以下婴幼儿为主，金黄色葡萄球菌感染以1岁以下婴儿为主，阳性检出男孩居多。多重耐药仍以志贺菌明显，细菌与轮状病毒混合感染的比例上升。

Objective To investigate the etiology, epidemiologic features and drug resistance tendency of acute infectious diarrhea among children in Beijing area. Methods Enteric pathogenic bacteria were isolated, cultured and identified for serotype from the stool specimens of children with the initial clinical diagnosis of acute bacterial diarrhea in the intestinal clinic from January to October in 2009, and the antibiotic susceptibility of bacteria was tested by disk diffusion method. The cluster A rotavirus antigen was also detected by the qualitative technique of immunochromatographic double-antibody sandwich assay. Results Of the 256 stool specimens, 87 strains of 4 species of pathogenic bacteria were detected with the detectable rate of 34. 0% ,of which 2 strains were detected in one stool sample ,including 40 strains of salmonella （46. 0% ） ,23 strains of shigella （26.4%） ,2 strains of diarrheogenic escherichia coli （2. 3% ） and 22 strains of staphylococcus aureus （25.3%）. The positively detected patients consisted of 54 males and 32 females with the ratio of 1.69： 1, of whom 55 cases （64.0%） were under 2 years of age. Of the 13 strains of shigeUa, 13 were sonnei shigella （56. 5 % ）. And of the 22 strains of staphylococcus aureus, 20 were detected among the infants under 1 year of age. The rates of drug resistance to certain antibiotics were lower in salmonella than in shigella （ ampicillin ：65.0% vs. 95. 7 % ; compound sulfamethoxazole ：20. 0% vs. 78. 3 % ; ciprofloxacin： 7. 5 % vs. 8.7% ;ceftriaxone： 15.0% vs. 73.9% ）. Of the 256 stool specimens ,47 were found positive for cluster A rotavirus,of whom 13 were also positive in stool bacteria culture. Conclusion Salmonella is the major pathogen among children with bacterial diarrhea in Beijing in 2009, and sonnei shigella is the main epidemic strains of shigella diarrhea. Infants under 2 years of age are the susceptible population of the above two species of bacteria, while staphylococcus aureus mainly infect the infants under 1 years of age. Multi-resistance in shigella is still serious. The incidence of mixed infections of bacteria and rotavirus increases in children with infectious diarrhea.