3年175例儿童细菌性痢疾的流行病学及临床分析

Epidemiological and clinical analysis on bacillary dysentery in 175 children in three years

目的：了解近3年儿童细菌性痢疾的流行病学与临床特点、菌群及耐药性变化。方法对某院2010-2012年儿科肠道门诊收治的经粪便培养确诊的175例细菌性痢疾患儿病历资料进行回顾性分析。结果儿童细菌性痢疾的发病高峰在7～9月份（占74．86％）；主要集中在1～3岁（不含1岁含3岁）、3～5岁（不含3岁含5岁）两个年龄段（分别占23．43％、25．14％）；临床表现主要为腹泻（100％）、阵发性腹痛（94．29％）、发热（77．14％），脓血便、里急后重的典型症状较以往减少。分离福氏志贺菌113株（64．57％），宋内志贺菌62株（35．43％）。药敏结果显示，175株志贺菌对氨苄西林、氨苄西林/舒巴坦、复方磺胺甲口恶唑有很高的耐药率，分别达到97．14％、72．57％、78．29％；对庆大霉素、环丙沙星、诺氟沙星、左氧氟沙星的敏感率仍较高（耐药率为4．57％～16．57％）；对头孢噻肟、头孢他啶的敏感率均在95％以上。结论儿童细菌性痢疾不典型病例在逐渐增多；本地志贺菌菌型以福氏志贺菌为主；志贺菌对一些抗菌药物的敏感性发生了较大变化，医生在使用抗菌药物时应引起重视。

Objective To investigate the epidemiological and clinical characteristics,pathogen species,and antimicrobial resistance of bacillary dysentery in children in recent three years.Methods Clinical data of 175 children with bacillary dysentery in a hospital in 2010-2012 were analyzed retrospectively. Results Peaks month of occurrence of bacterial dysentery in children was in July-September （74.86% ）,incidence in children in 1-3 years old group （1 year old was excluded,3 years old was included）was 23 .43% ,and in 3-5 years old group （3 years old was excluded,5 years old was included）was 25. 14% . The main clinical manifestations were diarrhea （100% ）,paroxysmal abdominal pain （94.29% ）,and fever （77.14% ）,but the typical symptoms of bloody purulent stool and tenesmus were less than the previ-ous. The isolation rate of Shigellaflexneri and Shigellasonnei was 64.57% （n= 113）and 35.43% （n= 62）respectively. Antimicrobial susceptibility test result revealed that the resistance rate of 175 Shigella isolates to ampicillin,ampicillin/sulbactam,and compound sulfamethoxazole was 97.14% ,72.57% ,and 78.29% respectively;sensitivity rate to gentamicin,ciprofloxacin,norfloxacin,and levofloxacin were still high ,resistance rates were 4.57% -16.57% ,sensitivity rate to cefotaxime and ceftazidime were up to more than 95% . Conclusion Atyptical bacillary dysentery in children increases gradually;the major Shigella in local area is Shigellaflexneri;Susceptibility of Shigella to some antimicrobial agents changed obviously,antimicrobial use should be paid attention.