青少年儿童腹泻病原学分析及耐药性监测

Analysis of etiology and drug resistance of infectious diarrhea among children and adolescents

目的对2008-2012年青少年儿童感染性腹泻的病原学及耐药性进行分析,为儿童腹泻的临床防治提供参考依据。方法采集758例初步诊断为急性细菌性腹泻病青少年儿童的粪便标本,进行常规细菌分离培养及其血清分型的鉴定,并采用纸片扩散法进行细菌药敏试验,此外,采用胶体金法检测轮状病毒抗原。结果 758例粪便标本中共检出细菌169株,检出率为22.3%,轮状病毒67株检出率为8.8%;合并细菌感染的有16例;主要病原体如福志贺菌、宋内志贺菌、沙门菌属和大肠埃希菌分别占18.2%,13.6%,17.4%和10.2%;此外,病原体均在<6岁儿童中高发,且以夏秋季节为高发季节,而轮状病毒感染则在秋冬季节高发;志贺菌属对磺胺甲噁唑/甲氧苄啶、氨苄西林及氨苄西林/舒巴坦的耐药率较高,分别为92.0%、84.0%、61.33%;而沙门菌属和大肠埃希菌对抗菌药物的敏感性更高。结论感染性腹泻病原菌种类多,主要病原体为志贺菌属和轮状病毒,同时应重视耐药性监测,合理使用抗菌药物。

OBJECTIVE To investigate the etiology, epidemiologic features, and drug resistance tendency of infec- tious diarrhea among children and adolescents in part area of Beijing from 2008 to 2012 so as to offer the data for guiding epidemiological study and clinical treatment. METHODS A total of 758 children and adolescents with initial clinical diagnosis of bacterial diarrhea were enrolled. The enteric pathogenic bacteria were isolated, cultured, and identified from fresh stool specimens. The antibiotic susceptibility of bacteria was tested by disk diffusion method. The antigen of rotavirus （RV） was also detected by qualitative technique of immunochromatographic double-anti- body sandwich assay. RESULTS A total of 169 stains of pathogenic bacteria were detected from the 758 stool spec- imens with the detection rate of 22.3%. 8.8% （67/758） stool specimens were positive for RV, of which 16 were also positive for the stool bacteria culture. The major species of pathogenic bacteria were S. flexneri, S. sonnei, Salmonella and Escherichia coli, with the percentages of 18.2%, 13.6%, 17.4% and 10.2% in the 169 strains of bacteria, respectively. In addition, the pathogenic bacteria were highly prevalent in the children aged under 6 years, especially in summer and fall, while the high-occurrence seasons for RV infections were fall and winter. Shigella spp were highly resistant to ampicillin, ampicillin-sulbactam, and trimethoprim-sulfamethoxazole, while Salmonella and E. coli were more susceptible to the antibiotics. CONCLUSION There are many species of enteric pathogenic bacteria causing infective diarrhea in Beijing area, and the major pathogens are Shigella and RV, meanwhile, it is necessary to attach great importance to the monitoring of drug resistance and the reasonable use of antibiotics.