2010年夏季急性细菌感染性腹泻患儿沙门菌感染分析

Analysis of Salmonella infection in children with acute bacterial diarrhea in 2010 summer

本文旨在了解急性细菌感染性腹泻患儿中沙门菌的感染现状及其耐药性。采集2010年7月1日~2010年9月30日复旦大学附属儿科医院门诊及住院急性细菌感染性腹泻患儿的粪便标本,进行沙门菌分离、培养及鉴定,采用Kirby-Bauer法进行药敏试验。共收集急性细菌感染性腹泻患儿粪便标本1 045份,检出沙门菌160株,阳性率为15.3%。其中〈1岁患儿沙门菌分离率为23.6%（119/505）,明显高于1~5岁患儿（7.6%,32/423）及〉5岁患儿（7.7%,9/117）（χ2=2 090,P〈0.001）。共分离到21种沙门菌血清型,其中鼠伤寒沙门菌占40.6%（65/160）,其次肠炎沙门菌占25.0%（40/160）,其余19种血清型占34.4%（55/160）。鼠伤寒沙门菌和肠炎沙门菌对氨苄西林的耐药率分别为91.4%和69.0%,对头孢曲松的耐药率分别为29.3%和6.9%,对头孢噻肟的耐药率分别为29.3%和6.9%;对头孢美唑、磷霉素的敏感率〉90%。结果显示,我院2010年夏季急性细菌感染性腹泻患儿中,沙门菌感染率较高,以〈1岁患儿为主,主要为鼠伤寒沙门菌、肠炎沙门菌感染,该2种致病菌对第3代头孢菌素均产生不同程度的耐药。

The current report aims to investigate the prevalence and resistance patterns of Salmonella in children with acute bacterial diarrhea.A total of 1 045 stool specimens were collected from outpatients and inpatients with acute bacterial diarrhea admitted to Children＇s Hospital,Fudan University,from 1 July to 30 September in 2010.Salmonella spp.was identified by culture isolation method.Antimicrobial susceptibility was tested via the Kirby-Bauer method.Salmonella was found in 160 specimens.The total infection rate was 15.3%（160/1 045）.The infection rate was 23.6%（119/505） in children under 1-year old,which was significant higher than those in children aged 1 to 5 years（7.6%,32/423） and older（7.7%,9/117）（χ2=2 090,P0.001）.Twenty-one serotypes of Salmonella were found.Salmonella typhimurium accounted for 40.6%（65/160）,Salmonella enteritidis accounted for 25.0%（40/160）,and the others accounted for 34.4%（55/160）.The resistance rates of Salmonella typhimurium and Salmonella enteritidis to ampicillin were 91.4% and 69.0%,to ceftriaxone 29.3% and 6.9%,and to cefotaxime 29.3% and 6.9%,respectively.The sensitivity rates of Salmonella typhimurium and Salmonella enteritidis to cefmetazole and fosfomycin were above 90%.These results suggest that Salmonella was the dominant pathogenic bacterium associated with acute bacterial diarrhea in children in our hospital in 2010 summer.The children under 1-year old were more susceptible to Salmonella infection.The prevalence serotypes were Salmonella typhimurium and Salmonella enteritidis and we found that they exhibited varying resistance to the third-generation cephalosporin.