儿童肠道感染病原菌分布及耐药性分析

Analysis of distribution and antimicrobial resistance of enteric pathogens among children

目的了解儿童腹泻的肠道病原菌分布、流行病学特征及耐药情况,指导临床合理应用抗菌药物。方法收集上海市儿童医院2008—2013年门诊和住院腹泻患儿的粪便标本中分离到的肠道病原菌;采用纸片扩散法对沙门菌属及志贺菌属进行6种抗菌药物的药敏试验。结果 5年期间共收集到肠道病原菌545株,其中沙门菌属为67.2%,其次为志贺菌属20.7%,金葡菌4.6%,空肠弯曲菌3.7%,气单胞菌属2.4%,致病性大肠埃希菌0.9%。患儿以男性稍多(56.3%),婴幼儿期(2岁以下)患儿占72.7%;夏、秋季为好发季节(72.9%)。志贺菌属对氨苄西林及甲氧苄啶-磺胺甲(口恶)唑耐药率均高于沙门菌属(P<0.05);福氏志贺菌对舒巴坦-氨苄西林、头孢曲松、环丙沙星、氯霉素的耐药率均显著高于宋内志贺菌(P<0.001)。68.3%的志贺菌属存在多重耐药现象,明显高于沙门菌的44.7%(P<0.001)。结论该院儿童腹泻的肠道感染病原菌种类多样,以沙门菌属和志贺菌属为主,具有性别、年龄、季节与地区分布的流行特征,耐药情况较为严重,不同菌属、菌种之间差异较大,应加强对病原菌及其耐药性监测,为控制儿童腹泻提供参考。

Objective To investigate the distribution,epidemiologic features and antibiotic resistance of the enteric pathogens isolated from children with diarrhea.Methods Enteric pathogens were isolatta from children＇s stool samples.The children with diarrhea were treated in the outpatient and inpatient of Shanghai Children＇s Hospital between 2008 and 2013.Antimicrobial susceptibility testing was conducted by disk diffusion method for Salmonella and Shigella with 6 antimicrobial agents.Results A total of 545 enteric pathogens were collected.Salmonella was the dominant pathogen,accounting for 67.2%,followed by Shigella（20.7%）,S.aureus（4.6%）,C.jejuni（3.7%）,Aeromonas（2.4%）,and enteropathogenic E.call（0.9%）.The main serotypes of Salmonella were S.typhimurium and S.enteritidis.Approximately 56.3%of the patients were boys.About 72.7%of the patients were infants under 2 years.The prevalence of diarrhea peaked in summer and autumn（72.9%）.The susceptibility of these isolates was only tested with seven antibiotics.Shigella showed higher level of resistance to ampicillin and trimethoprim-sulfamethoxazole than Salmonella（P〈0.05）.Significantly higher percentage of S.flexneri isolates were resistant to sulbactam-ampicillin,ceftriaxone,ciprofloxacin,and chloramphenicol than S.sonnei（P〈0.001）.Furthermore,the prevalence of multidrug resistant strains in Shigella（68.3%） was much higher than that in Salmonella（44.7%,P〈0.001）.Conclusions A variety of diarrhea-causing enteric pathogens are isolated from the children in Shanghai Children＇s Hospital.The isolates are predominantly Salmonella and Shigella species.The epidemiological features of Salmonella and Shigella species are different in terms of gender,age,season and geographical distribution.The resistance to antibiotics is a serious problem and varies with different types of pathogens.Intensive and ongoing surveillance of enteric pathogens and their changing resistant pattern is required to control diarrhea in children.