江西地区儿童志贺菌属感染流行趋势及耐药性变迁

Prevalence trends and drug resistance of Shigella infection in children of Jiangxi

目的了解儿童志贺菌属感染在江西地区的流行趋势、种群分布和耐药情况,为临床治疗儿童细菌性痢疾提供理论依据。方法回顾性分析我院2004年及2013年-2016年临床分离的志贺菌属;采用志贺菌诊断血清进行种群分析;纸片扩散法或自动化仪器法进行药物敏感性试验。结果 2004年共分离出176株志贺菌属,绝大多数为福氏志贺菌(162/176,92%),其次为宋内志贺菌(14/176,8.0%)。2013年-2016年4年间分离的志贺菌属逐年下降,分别为61、42、21和5株,其中4年间宋内志贺菌与福氏志贺菌比大致为1.7:1。2004年及2014年-2016年分离的志贺菌属对氨苄西林耐药率上升为100.0%,除复方新诺明的耐药率下降(4.2%)外其余抗菌药物(氨苄西林/舒巴坦、氨曲南、头孢吡肟、头孢噻肟、头孢他啶、环丙沙星)的耐药率均上升,分别上升的百分点为26.0%、73.8%、32.9%、21.8%、43.8%、41.1%。结论江西省儿童感染志贺菌的发病率逐年下降,十年间感染菌种发生了明显变化,原来腹泻儿童大部分感染福氏志贺菌,现在腹泻儿童大部分感染宋内志贺菌,对常用抗药物耐药率呈逐年增长趋势,感染控制部门仍应进行流行病学调查并加强耐药性监测。

Objective To investigate the epidemic trend,population distribution and drug resistance of Shigella infection in Jiangxi,and provide theoretical basis for clinical treatment of bacillary dysentery in children. Methods The clinical isolates of Shigella in 2004 and 2013-2016 years were retrospectively analyzed in Children＇s Hospital of Jiangxi Province. Population analysis was performed using Shigella diagnostic serum. Drug susceptibility tests were performed by disk diffusion or automated instrumental methods. Results A total of 176 strains of Shigella were isolated in 2004,the majority of which were Shigella flexneri（162/176,92%）,followed by Shigella sonnei（14/176,8%）. During the four years from 2013 to 2016,the amount of isolated Shigella strains decreased year by year,were 61,42,21 and 5 respectively,the ratio of Shigella sonnei and Shigella flexneri was approximately 1.7：1. In 2004 and 2014-2016 years,the resistance rate of Shigella to ampicillin increased to 100%. In addition to resistant compound sulfamethoxazole decreased（4.2%）. The resistance rates of other antibiotics（ampicillin/sulbactam,aztreonam,cefepime,cefotaxime,ceftazidime and ciprofloxacin） all increased. The rising percentages were 26%,73.8%,32.9%,21.8%,43.8%,41.1%,respectively. Conclusion The incidence of Shigella infection in children has been decreasing year by year in Jiangxi province.The infection has changed significantly in the past ten years from strains of Shigella flexneri mainly to Shigella sonnei. The rate of resistance to common drugs showed a trend of increasing year by year,and infection control department should still conduct epidemiological investigations and strengthen surveillance of drug resistance.