我国腹泻相关多重耐药病原菌分析与治疗选择

Diarrhea-related multidrug-resistant enteric pathogens in China

目的监测与腹泻相关的多重耐药菌,为临床合理用药及流行病学调查提供依据。方法收集2002-2010年我国北京、新疆、杭州、河南4个地区三级甲等医院的急性腹泻患者粪便标本,通过粪便培养,经生化及血清凝集试验鉴定出致病菌,并以纸片扩散法测定抗菌药物的敏感性,统计多重耐药菌。结果 9年中共分离到肠道病原菌1 742株,多重耐药菌874(50.17%)株;其中三重耐药肠道病原菌463(26.58%)株,四重及四重以上耐药肠道病原菌411(23.59%)株;肠道病原菌多重耐药产生率以志贺菌属居首位(65.42%),其次为致病大肠埃希菌(61.26%),再次为气单胞菌属、沙门菌属、类志贺毗邻单胞菌及弧菌属,分别占45.83%、37.38%、28.21%、19.44%。各年份多重耐药肠道病原菌对多种常用抗生素的耐药组合不尽相同:2002-2005年三重耐药的抗生素组合为氨苄西林、氯霉素及复方新诺明,分别占18.08%、10.48%、26.69%及48.60%,2006-2010年三重耐药抗生素的耐药组合为氨苄西林、头孢噻肟及复方新诺明,分别占32.14%、9.30%、7.69%、16.53%及11.01%;四重及四重以上的抗生素耐药组合最常见的为氨苄西林、氯霉素、复方新诺明及环丙沙星或诺氟沙星。结论我国感染性腹泻病原菌种类多,多重耐药肠道病原菌比例较高,且其对常用抗生素的耐药组合随时间变化。应加强监测,为临床合理用药提供依据。

Objective To study the rational use of drugs in clinical treatment and epidemiologic investigation of diarrhea-related multidrug-resistant enteric pathogens. Methods Stool samples, collected from acute diarrhea patients in 4 class A hospitals of Beijing, Xinjiang Uygur Autonomous Region, Hangzhou and Henan Province from 2002 to 2010, were cultured. Enteric pathogens were identified from the samples by biochemical and serum agglutination test. Their susceptibility and resistance to antibiotics were tested using paper strip method. Results Of the 874 （50.17%） multidrug-resistant strains isolated from 1 742 enteric pathogens in the past 9 years, 463 （26.58%） were resistant to 3 antibiotics and 411 （23.59%） were resistant to 4 or more antibiotics. The most common multidrug-resistant enteric pathogen was Shigella spp （65.42%） followed by Escherichia coli （61.26%）, Aeromonas spp （45.83%）, Salmonella spp （37.38%）, Plesiomonas shigelloides （28.21%） and Vibrio spp （19.44%）. The resistance of different multidrug-resistant enteric pathogens to ampicillin, chloramphenicol, trimethoprim and sulphame-thoxazole from 2002 to 2005 was 18.08%, 10.48%, 26.69% and 48.60% respectively, and to ampicillin, cefotaxime and trimethoprim and sulphame-thoxazole from 2006 to 2010 was 32.14%, 9.30%, 7.69%, 16.53% and 11.01%, respectively. Conclusion There exist many species of pathogens causing infectious diarrhea in China. The prevalence of multidrug-resistant enteric pathogens is high and their resistance to common antibiotics changes with time. It is therefore necessary to strengthen their monitoring in order to provide evidences for the rational use of drugs.