门诊急性感染性腹泻病原菌及其耐药性

Analysis of the distribution and the drug resistance of pathogenic bacteria in patients with acute infectious diarrhea in outpatient department

目的分析门诊急性感染性腹泻病原菌分布及药敏试验结果,为提高临床诊断治疗效率提供研究依据。方法选取2016年8月-2019年8月安徽省第二人民医院感染科门诊收治的86例急性感染性腹泻患者作为研究对象,对其流行病学特征及病原菌的分布、血清型、耐药性进行分析。结果男性患者占55.81%,20~40岁年龄占比最高为40.70%,有25.58%的患者出现了发热、脱水、电解质紊乱等全身性症状。采集的样本中共检出105株病原菌,其中,革兰阴性菌98株占93.33%,以沙门菌、志贺菌为主,沙门菌以鼠伤寒型、肠炎型为主;志贺菌以宋内Ⅰ型为主;革兰阳性菌7株占6.67%,均为金黄色葡萄球菌。副溶血性弧菌以O3:K6血清型为主,占62.50%;致泻性大肠埃希菌以O126血清型为主,占42.86%;金黄色葡萄球菌以SEA血清型为主,占57.14%。沙门菌对氨苄西林、庆大霉素、哌拉西林的耐药率较高,对氯霉素、氨曲南的耐药率较低;志贺菌对氨苄西林、庆大霉素、头孢唑林、阿米卡星、哌拉西林、头孢噻肟的耐药率较高。副溶血性弧菌对氨苄西林、庆大霉素、哌拉西林的耐药株数较多,致泻性大肠埃希菌对氨苄西林、头孢唑林的耐药株数较多,金黄色葡萄球菌对头孢呋辛、头孢噻肟的耐药株数较多。结论沙门菌和志贺菌仍然是导致感染性腹泻的主要病原菌,副溶血性弧菌、致泻性大肠埃希菌、金黄色葡萄球菌也具有一定的检出率,志贺菌等菌种的耐药性较强,临床医生应依据病原学检测和药敏试验结果合理制订抗感染治疗方案,从而提高治疗效果、改善患者的预后。

OBJECTIVE To analyze the distribution and the drug sensitivity of pathogenic bacteria causing acute infectious diarrhea in outpatient department,so as to provide research basis for improving the clinical diagnosis and treatment efficiency.METHODS Total of 86 patients with acute infectious diarrhea in AnHui No.2 Provincial People’s Hospital from Aug 2016 to Aug 2019 were recruited as the research subjects,whose epidemiological characteristics were collected and the distribution,serotypes,drug resistance of pathogenic bacteria were analyzed.RESULTS Male accounted for 55.81%in all patients,of whom the highest proportion was between the age of 20 and 40 years old,accounting for 40.70%.25.58%of the patients had the systemic symptoms such as fever,dehydration and electrolyte disorder.A total of 105 strains of pathogenic bacteria were detected in the collected samples,among which 98 strains were Gram-negative bacteria,accounting for 93.33%,of which Salmonella and Shigella were the main isolates.The types of typhoid and enteritis were dominant among Salmonella;sonnei typeⅠwas the main type of Shigella.Seven strains were Gram-positive bacteria,accounting for 6.67%,all of which were Staphylococcus aureus.Vibrio parahaemolyticus was mainly O3:K6 serotype,accounting for 62.50%.Diarrhoeal Escherichia coli was mainly O126 serotype,accounting for 42.86%;S.aureus was mainly SEA serotype,accounting for 57.14%.The drug resistance rates of Salmonella to ampicillin,gentamicin and piperacillin were higher,while the resistance rates to chloramphenicol and aztreonam were lower.The drug resistance rates of Shigella to ampicillin,gentamicin,cefazolin,amikacin,piperacillin and cefazolin were higher.V.parahaemolyticus was more resistant to ampicillin,gentamicin and piperacillin.There were more strains of diarrheogenic E.coli resistant to ampicillin and cefazolin,and more strains of S.aureus were resistant to cefuroxime and cefotaxime.CONCLUSION Salmonella and Shigella are still the main pathogenic bacteria leading to infectious diarrhea.V.parahaemolyticus,diarrhoeal E.coli and S.aureus also have certain rate to be detected.Shigella and other strains have strong drug resistance.Clinicians should formulate reasonable anti-infection treatment plan according to the results of pathogen detection and drug sensitivity test,so as to improve the treatment effects and prognosis of patients.