感染性腹泻临床与病原学分布特点及耐药分析

Clinical features, etiology distribution and drug resistance in patients with infectious diarrhea

目的探讨新疆地区感染性腹泻的临床及病原学分布特点,指导经验性治疗感染性腹泻,避免滥用抗菌药物。方法回顾性分析2009年8～10月及2010年5～10月新疆医科大学第二附属医院肠道门诊感染性腹泻患者的临床及病原学特点、药敏结果。结果以急性腹泻为首发症状就诊的183例患者中,26例(14.2%)粪便细菌培养阳性,其中志贺菌属感染14例(53.8%),大肠埃希菌属感染5例(19.2%),沙门菌属感染3例(11.5%),肺炎克雷伯杆菌、嗜水气单胞菌、摩氏摩根菌、雷氏普罗威登斯菌感染各1例(3.8%)。年龄≤60岁患者病原菌的检出率高于年龄﹥60岁者(P﹤0.05)。志贺菌属感染以黏液便、水样便为主,大肠埃希菌与沙门菌感染以稀便为主。志贺菌、大肠埃希菌及沙门菌普遍对氨苄西林耐药,对β-内酰胺酶类、头孢菌素类和喹诺酮类等抗菌药物产生不同程度的耐药性;尚未发现病原菌对碳青霉烯类抗菌药物产生耐药性。结论肠道门诊细菌感染性腹泻患者粪便细菌培养阳性率较低,仍以志贺菌属为主要病原菌。监测病原菌分布、药敏结果,合理选择抗菌药物对降低细菌耐药十分重要。

Objective To investigate the clinical features and etiological distribution of infectious diarrhea , direct the empirical treatment of infectious diarrhea and avoid the overuse of antibiotics. Methods Retrospective analysis was performed in the data of clinical and etiological characteristics and drug susceptibility in patients with infectious diarrhea in enteric diseases clinic, Second Affiliated Hospital of Xinjiang Medical University from August to October 2009 and from May to October 2010. Results Of 183 patients with acute diarrhea as first symptom, fecal bacterial culture were positive in 26 cases （14.2%）, including Shigella （14 cases, 53.8%）, E. coli （5 cases, 19.2%）, Salmonella （3 cases, 11.5%）, Klebsiella pneumoniae, Aeromonas hydrophila, Morganella morganii strains and Reid Provideneia stuartii （1 case in each infection, 3.8%）. The detection of pathogenic bacteria was dominant in young and middle-aged patients. The main characteristics of stool specimens in Shigella were mucous and watery, while those in E.coli and Salmonella were loose. Shigella, E.coli and Salmonella were generally resistant to ampicillin, and with some level of resistantance to common antimicrobial agents, such as β-1actams,cephalosporins and quinolones. Pathogens resistant to carbapenems were not found. Conclusions The bacterial culture positive rate of stool samples from patients with infectious bacterial diarrhea is not high in Second Affiliated Hospital of Xinjiang Medical University, with the main pathogenic bacteria of Shigella. Monitoring of pathogen distribution, drug resistance, and rational use of antibacterial drugs are very important.