天津市2007—2010年临床感染性腹泻病原谱及其特征

Pathogenic spectrum and its characteristics of infectious diarrhea in Tianjin,2007-2010

目的了解天津市感染性腹泻病的病原构成及其表型和分子生物学等特征。方法于2007—2010年天津市区5所哨点医院采集感染性腹泻患者粪便样本,检测腹泻病原菌。采用平板纸片扩散法检测志贺菌14种常用抗生素耐药性。结果样本中病毒阳性率为35.4(164/463),肠道病原菌阳性率为41.6%(178/428)。病毒性腹泻病原仍是诺如病毒(NV)和轮状病毒(RV)为主,阳性率分别为14.9%(69/164)和8.2%(38/164),RV基因型以G3和P[8]为主,分别占29.5%和24.1%。细菌性腹泻中志贺菌,宋内和福氏型,肠毒素Ⅰ、Ⅱ型多达53.5%。志贺菌对复方新诺明的耐药率高达94.8%(55/58),对氨苄西林的耐药率为58.6%(34/58),对诺氟沙星耐药率为34.5%(20/58),宋内志贺菌的耐药率更高,对上述3种抗生素的耐药率分别为100%(31/31)、87.1%(27/31)和61.3%(19/31),多重耐药普遍。结论天津市感染性腹泻疾病病原学趋于复杂,志贺菌耐药情况普遍。

Objective To study pathogenic spectrum of infectious diarrhea and its molecular biology characteristics. Methods Stool specimens were collected from patients with clinical diagnosis of infectious diarrhea at 5 sentinel disease surveillance hospitals in Tianjin city from 2007 through 2010 for detections of rotavirus（RV） ,norovirus（NV） ,Shigella, Escherichia coli, Salmonella, and other pathogens. Drug resistance of the isolated Shigella strains to 14 antibiotics frequently used in clinical treatment was assessed with disc diffusion test. Results The detection rate of virus was 35.4% （ 164/463 ） and that of enteric pathogenic bacteria was 41.6% （ 178/428 ） for the specimens. The major pathogens of viral diarrhea were NV and RV,with the detection rate of 14. 9% （69/164） for NV and 8.2% （38/164） for RV. The main genotypes of RV were G3 （29. 5 % ）and P 18 ] （24. 1% ）. The detected pathogenic bacteria included mainly Shigella, Vibrio parahaemolyticus ,and Salmonella. The main isolated Shigella strains were Shigella sonnei and Shigella flexneri and the major types of the Shigella toxin were type I and II enterotoxin （53.5%）. The drug resistance rate of the Shigella strains was up to 94.8% to sulfamethoxazole Co,58.6% to ampiciUin,and 34.5% to norfloxacin;the drug resistance rates of ShigeUa sonnei to the three antibiotics were much higher （100% ,87. 1% ,and 61.3% ）and the multi-drug resistance of the isolated Shigella sonnei strains was common. Conclusion The pathogenic spectrum of infectious diarrhea in Tianjin is complex and the drug resistance of isolated Shigella strains is common.