139例儿童鼠伤寒沙门菌肠炎的临床特点及耐药性分析

Clinical Characteristics and Drug Resistance Salmonella Typhimurium Enteritis in 139 Children

目的通过分析鼠伤寒沙门菌肠炎的临床特点以及耐药情况,指导本地区鼠伤寒沙门菌肠炎合理使用抗生素。方法回顾性分析2016年1月-2019年12月河源市妇幼保健院收治139例鼠伤寒沙门菌肠炎患儿的临床特点及耐药情况。结果发病高峰期为每年5-10月份。139例鼠伤寒沙门菌肠炎患儿中,2016年发病34例,2017年发病35例,2018年42例,2019年29例。2岁以下发病109例(78.42%),是主要发病年龄;139例患儿中,男86例,女53例,男女比例1.48:1。年龄最小7天,最大7岁,中位年龄1.14(0.67,1.81)岁。腹泻和发热为主要临床表现,所有患儿均有大便次数增多,大便性状多变,水样便伴黏液血丝63例(45.32%),发热130例(93.53%)。可合并其他系统疾病。实验室检查提示大便常规可见红细胞128例(92.09%),白细胞133例(95.68%),脓细胞48例(34.53%);血常规提示白细胞>12×109/L 65例(46.76%)、超敏C反应蛋白>8 mg/L 118例(84.89%);血清降钙素原>0.5 ng/L 82例(58.99%)。药敏提示对碳青霉烯类(美罗培南,亚胺培南)、喹诺酮类(环丙沙星、左氧氟沙星)无耐药菌株产生,β-内酰胺酶抑制剂合剂有较高敏感性,对第三代头孢菌素有不同程度耐药,氨苄西林、哌拉西林和头孢呋辛酯耐药率较高。4年共有27株多重耐药菌株。结论鼠伤寒沙门菌肠炎好发于2岁以下婴幼儿,夏秋季是高发季节。腹泻和发热是主要临床表现,本地区鼠伤寒沙门菌有耐药菌株和多重耐药菌,应根据药敏结果选择合理、足疗程使用抗生素,尽量减少耐药菌株产生。

Objective By analyzing the clinical characteristics and drug resistance of Salmonella typhimurium enteritis,it is instructed to use antibiotics in this area.Methods The clinical characteristics and drug resistance of 139 children with Salmonella typhimurium enteritis admitted to Heyuan Maternal and Child Health Hospital from January 2016 to December 2019 were retrospectively analyzed.Results The peak period of onset is from May to October every year.Among the 139 children with Salmonella Typhimurium enteritis,34 cases occurred in 2016,35 cases occurred in 2017,42 cases in 2018,and 29 cases in 2019.There were 109 cases(78.42%)under 2 years of age,which was the main age of onset.Among the 139 children,86 were male and 53 were female.The ratio of male to female was 1.48:1.The minimum age is 7 days,the maximum age is 7 years,and the middle age is 1.14(0.67,1.81)years.Diarrhea and fever are the main clinical manifestations.All children have increased stool frequency and change in stool characteristics.63 cases(45.32%)of watery stools with mucus bloodshot eyes and 130 cases(93.53%)of fever.Can be combined with other system diseases.Laboratory tests showed that 128 cases(92.09%)of red blood cells,133 cases(95.68%)of white blood cells,and 48 cases(34.53%)of pus cells were found in stool.118 cases(84.89%)with reactive protein>8 mg/L;82 cases(58.99%)with serum procalcitonin>0.5 ng/L.Drug susceptibility suggests that there are no drug-resistant strains of carbapenems(meropenem,imipenem)and quinolones(ciprofloxacin,levofloxacin),and theβ-lactamase inhibitor mixture is highly sensitive.The third-generation cephalosporins have different degrees of resistance,and the resistance rates of ampicillin,piperacillin and cefuroxime axetil are higher.In 4 years,there were 27 multi-drug resistant strains.Conclusion Salmonella typhimurium enteritis is common in infants and children under 2 years of age,and the high incidence season is in summer and autumn.Diarrhea and fever are the main clinical manifestations.Salmonella typhimurium in this area has drug-resistant strains and multi-drug resistant bacteria.The antibiotics should be selected according to the results of drug sensitivity and the use of antibiotics in the course of foot treatment to minimize the production of drug-resistant strains.