162例小儿鼠伤寒沙门菌肠炎临床特点及耐药性分析

Clinical Characteristics and Drug Resistance of Salmonella Typhimurium Enteritis in 162 Children

目的:回顾性分析小儿鼠伤寒沙门菌肠炎的临床特点及耐药情况,指导临床合理使用抗菌药物。方法:回顾性分析2011-2016年我院收治的162例鼠伤寒沙门菌肠炎患儿的临床资料及药敏数据,总结其临床特点及耐药情况。结果:共162例患儿大便分离培养出鼠伤寒沙门菌,占同期大便分离沙门菌属的68.64%,是沙门菌属的主要致病血清型,其中116例(71.60%)有不洁饮食史。162例鼠伤寒沙门菌肠炎患儿中男109例(67.28%),女53例(32.72%),年龄1.12(0.25,5.00)岁,以婴儿为主(60.49%),夏季为发病高峰(58.64%)。本组鼠伤寒沙门菌肠炎患儿主要临床表现为发热(93.21%),大便含黏液及血(90.74%);实验室检查可见大便含不同程度的白细胞(95.06%)、红细胞(88.27%)及脓细胞(58.64%),多伴血C反应蛋白增高(65.43%)及白细胞计数增高(62.96%)。162株鼠伤寒沙门菌对抗菌药物的耐药率由低到高依次为:头孢曲松(12.96%)、环丙沙星(14.81%)、头孢噻肟(17.28%)、复方磺胺甲唑(35.80%)、氨苄西林(81.48%)。18株(11.11%)对3种以上抗菌药物耐药,7株(4.32%)对所有抗菌药物均敏感。结论:鼠伤寒沙门菌是沙门菌属的主要致病血清型,鼠伤寒沙门菌肠炎好发于1岁以内的婴儿,夏季为发病高峰。本地区鼠伤寒沙门菌有耐药株及多重耐药株,对氨苄西林高度耐药,对第三代头孢菌素及含酶抑制剂的第三代头孢菌素较敏感。

Objective：To retrospectively analyze the clinical characteristics and drug resistance of Salmonella typhimurium enteritis in children,so as to guide the clinical rational drug use.Methods：Retrospective analysis was conducted on clinical characteristics and drug susceptibility from 162 children with Salmonella typhimurium enteritis admitted into our hospital from 2011 to 2016.Results：Totally 162 cases of children were isolated and cultured from feces,accounting for 68.64% of the total in the meantime.They were the main pathogenic serotype of Salmonella,among which 116 cases（71.60%） had a history of unclean diet.Among the 162 children with Salmonella typhimurium enteritis,109（67.28%） were males and 53（32.72%） were females.The age was 1.12（0.25,5.00）years old,mainly focus on infants（60.49%） and summer had the peak of incidence（58.64%）.The main clinical manifestations of children with Salmonella typhimurium enteritis were fever（93.21%）,mucus and blood（90.74%）;laboratory examination revealed that the stool contained different levels of white blood cells（95.06%）,red blood cells（88.27%） and pus cells（58.64%）,increased C-reactive protein（65.43%） and increased WBC count（62.96%）.The resistance rates of 162 strains of Salmonella typhimurium to antibiotics were as follows：ceftriaxone（12.96%）,ciprofloxacin（14.81%）,cefotaxime（17.28%）,compound sulfamethoxazole（35.80%） and ampicillin（81.48%）.There were 18 strains（11.11%） resistant to more than 3 antibiotics,and 7 strains（4.32%） were sensitive to all antibiotics.Conclusion：Salmonella typhimurium is the main pathogenic serotype of Salmonella.The incidence of Salmonella typhimurium enteritis in infants under the age of 1 year is high in summer.There are resistant strains and multi-drug resistant strains of Salmonella typhimurium in this region,which are highly resistant to ampicillin and sensitive to the thirdgeneration cephalosporins and the third-generation cephalosporins containing enzyme inhibitors.