白银市感染性腹泻病原菌监测及耐药性分析

Surveillance and analysis of infectious diarrhea pathogens and drug resistance in Baiyin city

目的了解2018—2020年甘肃省白银市感染性腹泻的流行特征、主要病原菌及其耐药情况。方法收集"十三五国家科技重大专项"腹泻症候群监测结果,采集哨点医院急性腹泻就诊病例的粪便样本,检测常见致泻病原菌并进行药物敏感性试验。结果共采集感染性腹泻患者粪便标本452份,检出菌株150株、总检出率33.19%,其中致泻大肠埃希菌(diarrheogenic Escherichia coli, DEC)145株、检出率32.08%,志贺菌4株、检出率0.88%,沙门菌1株、检出率0.22%;以5岁及以下儿童为主、占62.61%,且病原菌检出率最高(37.10%);6—9月检出率较高;DEC对氨苄西林的耐药率最高(82.07%),对头孢唑林、萘啶酸、复方磺胺和四环素的耐药率均在60.00%以上,5种DEC对除亚胺培南外的12种抗生素耐药率差异均有统计学意义(P<0.05),而对亚胺培南耐药率差异无统计学意义(χ^(2)=3.783,P>0.05);145株DEC分为70种耐药谱,同时耐受3种及以上抗生素的菌株113株、占77.93%。结论白银市感染性腹泻主要病原菌为DEC,该菌对多种抗生素存在不同程度的耐药,耐药谱广泛而复杂;应重点关注5岁及以下儿童的感染。

Objective To understand the epidemic characteristics, main pathogens and drug resistance of infectious diarrhea in Baiyin city from 2018 to 2020. Methods The surveillance result of diarrhea syndrome according to the "National Science and Technology Major Project of the 13 th Five-year Plan", and the fecal samples of the patients with acute diarrhea in sentinel hospitals were collected for detecting common diarrheal pathogens and testing the drug susceptibility. Results There were 150 bacteria strains detected among total 452 fecal samples collected from infectious diarrhea patients, with the detection rate of 33.19%. There were 145 strains of diarrheogenic Escherichia coli(DEC) with detection rate of 32.08%, 4 strains of Shigella with detection rate of 0.88%, and 1 strain of Salmonella with the detection rate of 0.22%. The patients of 5 year-old and younger were the main, accounting for 62.61%, with the highest pathogen detection rate of 37.10%. The detection rate was high from June to September. The rate of drug resistance of DEC was the highest to ampicillin(82.07%),and higher than 60.00% to cefazolin, nalidixic acid, compound sulfanilamide and tetracycline. There were statistical differences(P<0.05) in the resistance rates of 5 DEC to 12 antibiotics except for imipenem, without statistical difference(χ^(2)=3.783, P>0.05) in the resistance rates of 5 DEC to imipenem. There were 70 spectrums of drug resistance among 145 DEC strains, and 113 strains resisted 3 antibiotics and more, accounting for 77.93%. Conclusions DEC is the main pathogenic bacteria causing infectious diarrhea in Baiyin city, and exists drug resistance kinds of antibiotic to varying degrees, with wide and complex spectrums of drug resistance. Special attention should be paid to the infection in children of 5 year-old and younger. The spectrum of resistance is complex. Children of 5 years old and younger should be the focus of attention.