宁波地区腹泻病人中食源性致病菌检测与分析

Etiological surveillance and analysis of diarrhea of foodborne bacterial pathogens in Ningbo City

目的:了解宁波地区感染性腹泻病人中致病菌构成和耐药性,为防控腹泻病提供依据。方法:致病菌检测采用直接分离与增菌分离相结合的方法;细菌鉴定采用生化筛检和API等,鉴定到种、群;致病菌血清分型采用血清凝集法;药敏试验采用K-B法,耐药基因检测采用PCR法。结果:9 256份标本检出8类16种3 473株病原菌,检出率为37.52%,以副溶血性弧菌最多,沙门菌次之,气单胞菌第三,且副溶血性弧菌的检出率明显高于其它病原菌,差异有统计学意义(P<0.01);血清分型发现副溶血性弧菌的O:3群、沙门菌的甲型副伤寒、志贺菌的褔氏志贺菌、致病性大肠杆菌O:119为各病原菌的优势菌,检出了褔氏1C等志贺菌新亚型;药敏试验显示致病菌对大多数抗生素敏感,但有45株为多重耐药菌,其中气单胞菌23株、志贺菌8株、致泻性大肠杆菌8株、金黄色葡萄球菌3株、变形杆菌2株、沙门菌1株,占总菌数的2.45%,检出了bla-TEM、sull和aacc等3种耐药基因。结论:宁波地区腹泻食源性致病菌构成复杂,副溶血性弧菌是最主要的流行病原菌;检出褔氏C型志贺菌提示其血清型可能或正在转换,需加强对志贺菌变迁的监测,以预防疾病的暴发;致病性不强的气单胞菌和类志贺邻单胞菌检出率较高,应引起关注;病原菌对多种抗生素敏感,可用于预防和治疗。有2.45%的病原菌为ESBL,涉及多个菌属,说明耐药菌产生的复杂性,采取合理用药是关键,以减少耐药菌的传播和扩散。

Objective To explore the pathogenic form, drug resistance distribution of the pathogenic bacteria causing diarrhea in Ningbo. Methods A total of 9 256 samples of diarrheal patients were collected. Pathogenic bacteria were analyzed by direct isolation culture combined with enrichment isolation culture. Biochemical identification and API were used for identifying bacteria. Serotypes were clarified by the serology--agglutinating test. Antimicrobial susceptibility was determined by K-B disk diffusion method and PCR was used for detecting multidrug resistance. Results 3 474 （37.52%）strains belonging to 16 species and 8 types were isolated from the total 9 256 specimens by pathogen detec- tion. Vibrio Parahemolyticus, salmonella and aero monas were the main pathogenic bacteria in infectious diarrhea pa- tients,for which the positive rates were 20. 99%,3.99% and 3.44% respectively. The findings of serotype indicated that 0：3 among vibrio Parahemolyticus, paratyphoid A among Salmonella, Sh. flexneri among shigella dysenteriae and O：119 among enteropathogenic E. Coli were dominant bacteria. Shigellae F1C, 2C, 4C were found. Pathogenic bacteria were sensitive to most antibiotics. However,45 strains of multidrug--resistant bacteria were found. Conclusions Vibrio Parahernolyticus are the main pathogenic bacteria in infectious diarrhea patients in Ningbo. The finding of Shigellae F1C suggests the change of the serotype of shigellae. Surveillance for the serotype change of shigellae should be strengthened.