重庆市黔江区2018-2020年感染性腹泻病原菌流行病学特征分析

Epidemiological characteristics of infectious diarrhea pathogens from 2018 to 2020 in Qianjiang district of Chongqing

目的了解2018-2020年重庆市黔江区感染性腹泻患者的病原流行病学特点,为该地区感染性腹泻的诊治提供依据。方法收集2790例腹泻患者粪便标本,检测细菌、真菌、病毒和寄生虫。细菌和真菌采用鉴别培养基和微生物鉴定仪确定菌株,病毒采用PCR方法检测核酸或免疫层析法检测病毒抗原,寄生虫采用集卵法镜检检测。同时收集感染性腹泻患者临床资料。结果2790例腹泻患者中有382例患者病原学检测阳性,阳性率为13.69%。病原菌种类以细菌(28.27%)、病毒(56.54%)、真菌(6.81%)为主,其中轮状病毒、沙门菌属和白色念珠菌为主要致病菌。2018年、2019年及2020年病原菌检出率比较差异无统计学意义(χ^(2)=0.558,P>0.05),但2019年检测到的病原菌以细菌为主,检出率高于2018年及2020年。各季节间病原菌检出率比较差异有统计学意义(χ^(2)=8.636,P<0.05),春季腹泻患者病原菌分离率显著低于其他季节(χ^(2)=7.105,P<0.05),同时,冬季病毒感染构成比明显高于其他季节,差异有统计学意义(χ^(2)=14.851,P<0.05)。男性检出病原菌构成比(62.83%)高于女性(37.17%),年龄段以>6个月至2岁(39.53%)和>18岁(25.39%)2个阶段病原菌构成比较高。城市检出病原菌比例(55.76%)高于农村(44.24%),但农村感染性因素引起腹泻比例(21.47%)远高于城市(10.63%)。感染性腹泻患者主要临床表现为腹痛、腹泻,粪便性状以水样便为主。结论重庆市黔江区感染性腹泻患者病原菌以轮状病毒和沙门菌属居多,冬季以轮状病毒感染为主,应重视>6个月至2岁患儿出现感染性腹泻时的诊治。

Objective To understand the pathogenic epidemiological characteristics of patients with infectious diarrhea in Qianjiang district of Chongqing from 2018 to 2020,and to provide a basis for the diagnosis and treatment of the disease in this region.Methods Stool specimens of 2790 patients with diarrhea were collected to detect bacteria,fungi,viruses and parasites.Bacteria and fungi were identified by identification medium and microbial identification instrument.Viruses were detected by PCR for nucleic acid or immunochromatography for viral antigen.Parasites were detected by microscopy with flag method.At the same time,the clinical data of patients was collected.Results A total of 382 patients tested positive for etiology among 2790 patients with diarrhea,with a positive rate of 13.69%.The pathogenic species were dominated by bacteria(28.27%),viruses(56.54%)and fungi(6.81%),with rotavirus,Salmonella spp.and Candida albicans as the main causative agents.There was no significant difference in the detection rate of pathogens in 2018,2019 and 2020(χ^(2)=0.558,P>0.05),but the pathogens detected in 2019 were mainly bacteria,with higher detection rates than in 2018 and 2020.The detection rate of pathogenic bacteria in different seasons was significantly different from each other(χ^(2)=8.636,P<0.05).The isolation rate of pathogenic bacteria in patients with diarrhea in spring was significantly lower than that in other seasons(χ^(2)=7.105,P<0.05).At the same time,the composition ratio of virus infection in winter was significantly higher than that in other seasons,there was significant difference(χ^(2)=14.851,P<0.05).Males had a higher percentage of pathogenic bacteria(62.83%)than females(37.17%).The composition ratio of pathogenic bacteria in age group was the highest at>6 months to 2 years old(39.53%)and>18 years old(25.39%).In the urban-rural composition ratio,the proportion of pathogenic bacteria detected in urban areas(55.76%)was higher than that in rural areas(44.24%),but the proportion of diarrhea caused by infectious factors in urban areas(10.63%)was much lower than that in rural areas(21.47%).The main symptoms of patients with infectious diarrhea were abdominal pain and diarrhea,and the main type of stool was watery stool.Conclusion Rotavirus and Salmonella are the most common pathogens in patients with infectious diarrhea in Qianjiang district of Chongqing.Rotavirus infection is the main cause in winter.The diagnosis and treatment of infectious diarrhea in children aged>6 months to 2 years old should be taken seriously.