婴幼儿腹泻人群中鼠伤寒沙门菌的流行病学及多重耐药特征研究

Epidemiological characteristics and drug resistance characteristics of Salmonella typhimurium in infants and young children with diarrhea

目的了解2014-2018年徐州地区婴幼儿腹泻患者中鼠伤寒沙门菌的流行病学特征和耐药特征,提高对鼠伤寒沙门菌肠炎的流行及耐药性的认识。方法收集2014-2018年徐州市医院门诊就诊的婴幼儿(0~3岁)腹泻粪便标本,进行沙门菌病原学检测,用描述流行病学方法对鼠伤寒沙门菌的流行特征进行分析。用最低抑菌浓度法测定鼠伤寒沙门菌对常见抗生素的敏感性,用双纸片协同法来确定产超广谱β-内酰胺酶(ESBLs)耐药表型,用PFGE进行分子分型研究。结果1343份腹泻标本中检出178株沙门氏菌,其中鼠伤寒沙门菌为72株(5.36%);5年间,沙门菌(χ趋势^2=21.23,P<0.01)和鼠伤寒沙门菌检出率呈逐年上升趋势(χ趋势^2=16.02,P<0.01);鼠伤寒血清型在沙门菌中的占比为40.45%,亦呈逐年增高的趋势(χ趋势^2=18.47,P<0.01)。90.28%的鼠伤寒沙门菌为多重耐药菌,对临床首选儿科用药-头孢他定(25.0%)和头孢曲松(37.50%)的耐药率均高于20%;产ESBLs表型阳性株对氨苄西林/他唑巴坦(χ^2=4.57,P<0.05)、头孢吡肟(χ^2=38.66,P<0.01)、氨曲南(χ^2=45.53,P<0.01)的耐药率高于非产ESBLs表型株。9株多重耐药鼠伤寒沙门菌出现4簇100%一致PFGE带型。结论近5年,婴幼儿腹泻患者中鼠伤寒沙门菌感染率较高,多重耐药现象严重,存在小范围传播的可能。

To understand the epidemiological characteristics and drug resistance characteristics of Salmonella typhimurium in infants and young children with diarrhea in Xuzhou area from 2014 to 2018,and to improve the understanding of the epidemic and drug resistance of salmonella typhimurium enteritis.The diarrhea stool samples of infants and young children(0~3 years old)from the outpatient clinics of Xuzhou Hospital from 2014 to 2018 were collected and tested for the pathogenicity of Salmonella.The descriptive epidemiological methods were used to analyze the epidemiological characteristics of Salmonella typhimurium.The minimum inhibitory concentration method was used to determine the sensitivity of Salmonella typhimurium to commonly used antibiotics,the double-sheet synergy method was used to determine the broad-spectrum β-lactamase(ESBLs)-resistant phenotype,and PFGE was used for molecular typing.As a result,178 Salmonella strains were detected in 1343 diarrhea specimens,among which 72 strains were Salmonella typhimurium(5.36%).The detection rate of Salmonella and Typhoid Salmonella showed an upward trend year by year(χ趋势^2=21.23,P<0.01;χ趋势^2=16.02,P<0.01);The proportion of typhoid serotype in Salmonella was 40.45%,which also increased year by year(χ趋势^2=18.47,P<0.01).Moreover,93.06%of Salmonella typhimurium was multi-drug-resistant bacteria,and the resistance rate to clinically preferred pediatric drugs is higher than 20%,with ceftazidime(25.0%)and ceftriaxone(37.5%),ESBLs-producing strains were shown in the higher resistance rates to ampicillin/tazobactam(χ^2=4.57,P<0.05),cefepime(χ^2=38.66,P<0.01),and aztreonam(χ^2=45.53,P<0.01)were higher than those of non-ESBLs-producing strains.Nine strains of Salmonella typhimurium showed 100%consistent with PFGE bands.In conclusion,in the past five years,among infants and young children with diarrhea,the infection rate of Salmonella typhimurium infection were increased.