2013-2017年河南省婴幼儿志贺菌流行特征与耐药分析

Epidemiological characteristics and drug resistance surveillance of Shigella in infants and young children in Henan Province from 2013 to 2017

目的了解河南省2013-2017年婴幼儿志贺菌的病原学特征。方法以河南省5岁以下腹泻患儿5 149份粪便分离的606株志贺菌为研究对象,采用血清分型、药物敏感试验及聚合酶链式反应(polymerase chain reaction,PCR)检测毒力基因方法,对其进行病原学检测。结果儿童志贺菌总检出率为11. 77%(606/5 149),1~岁年龄组幼儿检出率最高,为24. 08%;606株志贺菌共分为2群、11种血清型,其中福氏志贺菌占73. 43%,宋内志贺菌占26. 57℅。176株志贺菌对氨苄西林、萘啶酸的耐药严重(耐药率> 90%),对氯霉素、环丙沙星,诺氟沙星、复方新诺明的耐药率> 65%,对亚胺培南和头孢类抗生素敏感度较高,且福氏与宋内志贺菌耐药有差异。婴幼儿毒力基因组合模式以sh ET-1+、sh ET-2+、ipa H+、ial+为主,并检出5株无毒力株。结论河南省婴幼儿细菌性痢疾以福氏志贺菌为主,对常用的抗生素存在严重的耐药问题,不同血清型菌株携带优势基因模式不同。

Objective To investigate the pathogenic characteristics of Shigella in infants from 2013 to 2017 in Henan Province. Methods From 2013 to 2017,606 Shigella strains were isolated from5 149 children with diarrhea under 5 years old in Henan Province. Serotyping,drug sensitivity test and Polymerase Chain Reaction detection of virulence gene methods were used to detect the pathogen of Shigella. Results The detection rate of Shigella in children with diarrhea was 11. 77%,and the highest detection rate was in the 1-2 age group( 24. 08%). 606 Shigella strains were divided into two groups and 11 serotypes. Shigella flexneri accounted for 73. 43%,and Shigella sonnei accounted for 26. 57%. Resistance of 176 Shigella strains to ampicillin and naphthidine was serious( resistance rate > 90%),and the resistance rates to chloramphenicol,ciprofloxacin,norfloxacin and compound sulfamethoxamine were higher than65%,and the sensitivity of imipenem and cephalosporin were higher. There were differences in drug resistance between Shigella flexneri and Shigella sonnei. The virulence genes of infants were mainly sh ET-1 +,sh ET-2 +,ipa H + and ial +,and 5 avirulent strains were detected. Conclusions The bacterial dysentery of infants in Henan Province is dominated by Shigella flexneri. There are serious resistance and multidrug resistance to common antibiotics,and the dominant genes in different serotyping strains are different.