2018年北京市房山区弯曲菌监测结果及耐药性分析

Surveillance results and antibiotic susceptibility analysis of Campylobacter in Fangshan District of Beijing in 2018

目的了解2018年北京市房山区哨点医院腹泻患者和生禽鸡的弯曲菌感染情况及药物敏感情况,为弯曲菌防治工作提供依据。方法2018年1-12月在北京市房山区2家哨点医院收集未用抗生素的腹泻患者粪便标本进行弯曲菌、沙门菌、副溶血弧菌、志贺菌、5种致泻性大肠埃希菌及轮状病毒和诺如病毒的分离培养和鉴定;对生禽鸡进行弯曲菌、沙门菌和单增李斯特菌的分离、培养、鉴定;对分离到的空肠弯曲菌开展药物敏感试验。结果收集395例腹泻患者的粪便标本,男性212例,女性183例,其中16~45岁患者占66.08%。其中病原菌阳性的患者160例,阳性率为40.51%,检出病原菌共176株。弯曲菌检出53株,阳性率为13.41%;致泻大肠菌检出34株,阳性率为8.61%;沙门菌检出20株,阳性率为5.06%;副溶血性弧菌检出20株,阳性率为5.06%;志贺菌检出0株,阳性率为0%;轮状病毒检出26株,阳性率为6.58%;诺如病毒检出23株,阳性率为5.82%。人粪便标本检出弯曲菌的病例中37名男性和16名女性感染比较,差异有统计学意义(17.45%vs8.74%,χ^2=6.413,P<0.05)。40只生禽鸡中,共31只检出病原菌(77.5%),检出病原菌36株,其中沙门菌13株,弯曲菌23株。人粪便标本和生禽鸡检出的空肠弯曲菌对萘啶酸、环丙沙星、四环素的耐药率均大于80%,生禽鸡中的空肠弯曲菌对氟苯尼考的耐药率为90%,而人粪便标本中的空肠弯曲菌对氟苯尼考的耐药率为53.33%;红霉素、阿奇霉素、泰利霉素、克林霉素、链霉素和庆大霉素的敏感性大于80%。结论北京市房山区腹泻患者弯曲菌感染率高,空肠弯曲菌对萘啶酸、环丙沙星和四环素耐药严重;腹泻患者病原菌种类多,在继续加强监测的同时开展宣传教育。

Objective To understand the Campylobacter infection and antibiotic susceptibility of diarrhea patients from sentinel hospitals and poultry chickens in Fangshan District of Beijing in 2018,provide evidence for the prevention and control of Campylobacter.Methods Stool samples of diarrhea patients without antibiotics were collected from two sentinel hospitals in Fangshan District of Beijing from January to December in 2018.Campylobacter,Salmonella,Vibrio parahaemolyticus,Shigella,diarrheagenic Escherichia coli,rotavirus and norovirus isolation and identification were performed in stool samples.Campylobacter,Salmonella and Listeria monocytogenes isolation and identification were performed in poultry chickens.The antibiotic susceptibility test was performed on isolated Campylobacter jejuni.Results A total of 395 stool samples of the diarrhea patients were collected,including 212 males and 183 females,of which 66.08%were patients aged 16-45 years old.A total of 160 patients were positive for pathogenic bacteria with the positive rate of 40.51%,and a total of 176 pathogenic bacteria were detected.The detection rate of Campylobacter was 13.41%(53/395),the detection rate of diarrheagenic Escherichia coli was 8.61%(34/395),the detection rate of Salmonella was 5.06%(20/395),and the detection rate of Vibrio parahaemolyticus was 5.06%(20/395),the detection rate of Shigella was 0%(0/395),the detection rate of rotavirus was 6.58%(26/395),and the detection rate of norovirus was 5.82%(23/395).There was statistically significant difference in Campylobacter in human stool samples between 37 men and 16 women(17.45%vs 8.74%,χ^2=6.413,P<0.05).Among 40 poultry chickens,pathogenic bacteria were detected in 31 poultry chickens(77.5%),and there were 36 strains of pathogenic bacteria including 13 strains of Salmonella,and 23 strains of Campylobacter.The resistant rate of Campylobacter jejuni to nalidixic acid,ciprofloxacin,and tetracycline were greater than 80%in both human stool samples and poultry chickens.The resistant rate of Campylobacter jejuni to flufenicol was 90%in poultry chickens,while that was 53.33%in human stool samples.The sensitive rate of Campylobacter jejuni to erythromycin,azithromycin,telithromycin,clindamycin,streptomycin,and gentamicin was greater than 80%.Conclusion The rate of Campylobacter infection among diarrhea patients is high in Fangshan District of Beijing.Campylobacter jejuni is highly resistant to nalidixic acid,ciprofloxacin and tetracycline.There are many types of pathogens in patients with diarrhea.Publicity and education should be carried out while continuing to strengthen monitoring.