上海市浦东新区2013至2019年腹泻患者小肠结肠炎耶尔森菌流行特征分析

Epidemiological characteristics of Yersiniaenterocolitica in patients with diarrhea from 2013 to 2019 in Pudong New Area,Shanghai

目的探讨上海市浦东新区腹泻患者小肠结肠炎耶尔森菌的流行特征状况。方法回顾性分析2013年1月至2019年12月,上海市浦东新区疾病预防控制中心所在区的3所三级医院、9所二级医院和2所社区卫生服务中心的腹泻病原主动监测情况,使用冷增菌法分离小肠结肠炎耶尔森菌,并分析菌株生物/血清型、毒力基因型和抗微生物药物敏感性。使用χ^(2)检验或Fisher确切概率法进行率的比较。结果2013年1月至2019年12月共纳入腹泻患者12941例,0.7%(88/12941)患者经确认感染小肠结肠炎耶尔森菌。67.0%(59/88)患者为单一感染,33.0%(29/88)患者为混合感染。年度病原检出率呈升高趋势(0.3%~1.2%)。<5岁年龄组(1.1%,37/3218)和春季(1.1%,32/2998)检出率最高(χ^(2)分别为18.64和9.76,P<0.05)。58.0%(51/88)患者的粪便性状为水样便,15.9%(14/88)患者有发热症状,14.8%(13/88)患者有呕吐症状。3/O:3型为优势菌型(53.4%,47/88),其次为1A/O:8型(15.9%,14/88)和1A/O:5型(6.8%,6/88)。3/O:3型在<5岁年龄组占比89.2%(33/37)。所有3/O:3型菌株4种致病性毒力基因(ail、ystA、yadA、virF)均阳性,11/14的1A/O:8型菌株和4/6的1A/O:5型菌株ystB基因阳性。对氨苄西林(80.7%,71/88)和阿莫西林/克拉维酸(71.6%,63/88)的耐药率最高,63.6%(56/88)菌株为多重耐药。3/O:3型和非3/O:3型菌株间对氨苄西林、头孢西丁、萘啶酸、四环素、氨苄西林/舒巴坦耐药率比较,差异均有统计学意义(χ^(2)分别为14.68、43.80、41.86、30.54、5.07,P<0.05)。结论小肠结肠炎耶尔森菌在上海市浦东新区腹泻儿童中的检出率高于成人,优势菌型为致病性和多重耐药性的3/O:3型。

Objective To investigate the epidemiological characteristics of Yersinia enterocolitica in patients with diarrhea in Pudong New Area,Shanghai.Methods Active surveillance of diarrhea was conducted in 14 sentinel hospitals(three tertiary-level hospitals,nine secondary-level hospitals,and two primary-level hospitals)from January 2013 to December 2019 in Pudong New Area of Shanghai,China base on their location,catchment area,and patient volume.Cold enrichment method was used to isolate Y.enterocolitica and further detection of bioserotype,virulence genes and antimicrobial susceptibility of the isolates were conducted.The difference of rates was determined using chi-square test or Fisher′s exact test.Results A total of 12941 diarrhea cases were included,and 0.7%(88/12941)cases were confirmed with Yersinia enterocolitica infection.67.0%(59/88)cases were single infection,33.0%(29/88)cases were mixed infections.Detection rates of Y.enterocolitica increased annually(0.3%-1.2%)and were highest in children<5 years of age(1.1%,37/3218)and in spring(1.1%,32/2998)(χ^(2)were 18.64 and 9.76,respectively,P<0.05).58.0%(51/88)cases had watery diarrhea,15.9%(14/88)had fever and 14.8%(13/88)had vomiting.The predominant bioserotypes were 3/O:3(53.4%,47/88),followed by 1A/O:8(15.9%,14/88)and 1A/O:5(6.8%,6/88),respectively.Bioserotype 3/O:3 counted for the highest proportions(89.2%,33/37)in children<5 years of age.All the strains of bioserotype 3/O:3 harbored ail,ystA,yadA and virF genes,which encoded pathogenic Y.enterocolitica.11/14 strain of 1A/O:8 and 4/6 strains of 1A/O:5 harbored ystB gene.Most strains were resistant to ampicillin(80.7%,71/88)and amoxicillin/clavulanic acid(71.6%,63/88),and 63.8%(56/88)strains were multidrug resistance(MDR).The difference of antimicrobial resistance rates between 3/O:3 and non 3/O:3 was statistically significant in ampicillin,cefoxitin,nalidixic acid,tetracycline and ampicillin/sulbactam(χ^(2)was 14.68,43.80,41.86,30.54 and 5.07,respectively,P<0.05).Conclusion The detection rate of Yersinia enterocolitica was higher in children than in adults in Pudong New Area,Shanghai.The predominant bioserotype was pathogenic 3/O:3 with multidrug resistance.