2014-2018年浙江省余姚市非伤寒沙门菌监测及其耐药谱分析

Surveillance and drug resistance analysis of non-typhoid Salmonella in Yuyao, Zhejiang, 2014–2018

目的了解2014-2018年浙江省余姚市非伤寒沙门菌(NTS)的血清型流行趋势和耐药情况,为NTS的临床治疗和防控提供科学依据。方法 2014-2018年,利用亚硒酸盐煌绿(SBG)对余姚市哨点医院采集的腹泻患者样本进行增菌,采用选择性培养基分离培养NTS,并对NTS分离株进行血清型分型和药敏试验。结果从2 327份腹泻患者标本中共检出NTS 299株(12.85%),鉴定出35个血清型和1个未分型,前4位优势血清型为4,5,12:i:-沙门菌、鼠伤寒沙门菌、斯坦利沙门菌和肠炎沙门菌。NTS在夏季检出率最高(16.29%),冬季最低(2.33%)。<5岁的儿童在感染病例中占比59.87%。药敏结果显示NTS对青霉素类和头孢类抗生素耐药率高,对环丙沙星耐药率低,多重耐药菌株111株(37.12%)。对氨苄西林、氯霉素、链霉素、磺胺甲恶唑、四环素同时耐药(ACSSuT)的耐药模式主要存在于4,5,12:i:-沙门菌和鼠伤寒沙门菌中。结论余姚市NTS优势血清型为4,5,12:i:-沙门菌和鼠伤寒沙门菌。<5岁的儿童易感染NTS,应当加强5岁以下儿童的监测。NTS多重耐药现象严重,医疗机构应慎重选择临床病例的用药。

Objective To understand the spread and drug resistance of non-typhoid Salmonella(NTS) in Yuyao, and provide scientific basis for clinical treatment and prevention of NTS infection. Methods The samples of diarrhea patients collected from sentinel hospitals were tested for bacterial enrichment(using selenite brilliant green), isolation, identification,serotyping and drug susceptibility testing from 2014 to 2018. Results A total of 299 NTS strains(12.85%) were detected from 2 327 samples of diarrhea patients,and 35 serotypes and 1 unspecified serotype were identified. The first four predominant serotypes were S. 4,5,12:i:-, S. typhimurium, S. Stanley and S. enteritidis. The detection rate of NTS was highest in summer(16.29%) and lowest in winter(2.33%). The infection cases in children aged <5 years accounted for 59.87% of the total. Drug susceptibility test showed that NTS had high resistance rates to penicillin and cephalosporin, low resistance rate to ciprofloxacin. And 111 strains were multidrug resistant. The resistance pattern of ACSSuT mainly existed in S.4,5,12:i:-and S.typhimurium strains. Conclusion The predominant serotypes of NTS were S.4,5,12:i:-and S. typhimurium in Yuyao.Children aged <5 years were susceptible to NTS infection, suggesting that it is necessary to strengthen the surveillance in children aged <5 years. The multidrug resistance of NTS was serious. It is necessary to have a rational use of antibiotics in clinical practice.