湖南省郴州市2015—2020年幼儿腹泻沙门菌感染变迁及耐药性分析

Changes of Salmonella infection and drug resistance in children with diarrhea in Chenzhou,Hu’nan, 2015-2020

目的 调查近年来湖南郴州幼儿腹泻沙门菌感染变迁及耐药性,为郴州幼儿腹泻沙门菌感染流行病学研究及临床合理用药提供相关参考依据。方法 收集2015年1月—2020年12月湖南郴州门诊和住院的腹泻患儿,以粪便培养分离出沙门菌株的感染性腹泻病例作为研究对象,分析其变迁情况、血清型特征、临床表现及耐药性。结果 共收集1 854例腹泻患儿,其中采集粪便样本1 560份,培养分离得到沙门菌株248株(15.90%)。248例沙门菌感染腹泻患儿中,男女比例为1.58∶1,随着年龄增长沙门菌检出率呈下降趋势;2015—2020年期间,不同年份沙门菌检出率差异无统计学意义(P>0.05),5—10月是沙门菌感染的高发季节,其中7—10月为发病高峰;血清型以鼠伤寒沙门菌、肠炎沙门菌为主,分别占41.06%、21.14%;临床表现以发热、腹泻为主,其中有发热症状的患儿占95.56%,体温>39℃的患儿占75.81%;腹泻次数均≥3次/d,≥10次/d的患儿占32.26%;粪便性状中稀水便占46.38%,黏液便占29.84%,血便15.73%,脓血便6.85%;有腹痛症状的患儿占51.21%;有恶心呕吐症状的患儿占22.18%;有脱水症状的患儿占12.10%;鼠伤寒沙门菌对氨苄西林耐药率最高,为96.04%;对亚胺培南、阿奇霉素、阿米卡星、哌拉西林/他唑巴坦耐药率较低,分别为0、0、1.98%、4.95%;肠炎沙门菌对氨苄西林耐药率最高,为100.00%,对亚胺培南、阿奇霉素、阿米卡星、哌拉西林/他唑巴坦、庆大霉素、环丙沙星、甲氧苄氨嘧啶均无耐药性;其他血清型沙门菌对氨苄西林耐药率最高,为47.31%,对其他类型抗菌药物耐药率均不高。结论 近年来湖南郴州幼儿腹泻沙门菌感染呈平稳趋势,夏秋为高发季节,血清型以鼠伤寒沙门菌、肠炎沙门菌为主,临床表现以发热、腹泻为主,治疗优先选择的抗菌药物为亚胺培南、阿奇霉素、阿米卡星、哌拉西林/他唑巴坦等。

ObjectiveTo investigate the changes of Salmonella in children diarrhea in Chenzhou, Hunan in recent years,so as to provide relevant reference for the epidemiological study of Salmonella diarrhea in children in Chenzhou and the rational use of drugs.Methods2015 to December 2020 were collected. Infectious diarrhea cases with Salmonella strains isolated from fecal culture were used as the research object to analyze their changes, serotype characteristics, clinical manifestations and drug resistance.Results Salmonella strains(15.90%) were cultured and isolated. Among the 248 children with Salmonella infection and diarrhea, the ratio of male to female was 1.58∶1, and the detection rate of Salmonella showed a downward trend as the age increased;from2015 to 2020, there was no significant difference in the detection rate of Salmonella in different years(P>0.05), May to October was the season of high incidence of Salmonella infection, of which the peak incidence was from July to October;the serotypes were mainly Salmonella typhimurium and Salmonella enteritidis, accounting for 41.06% and 21.14% respectively;the main clinical manifestations were fever, diarrhea, among which 95.56% of children with fever symptoms, 75.81% of children with body temperature >39 ℃;diarrhea times ≥3 times/d, children with diarrhea ≥10 times/d account for 32.26%;stool traits:watery stools accounted for 46.38%, mucus stools 29.84%, bloody stools 15.73%, pus-blood stools 6.85%;children with abdominal pain symptoms accounted for 51.21%;children with nausea and vomiting symptoms accounted for 22.18%;children with dehydration symptoms accounted for 12.10%;Salmonella typhimurium had the highest resistance rate to ampicillin,96.04%;The resistance rates to imipenem, azithromycin, amikacin and piperacillin/tazobactam were 0.00%, 0.00%, 1.98% and4.95% respectively;Salmonella enteritidis had the highest resistance rate to ampicillin, which was 100.00%. It had no resistance to imipenem, azithromycin, amikacin, piperacillin/tazobactam, gentamicin, ciprofloxacin and trimethoprim;The drug resistance rate of other serotypes of Salmonella to ampicillin was the highest, 47.31%, and the drug resistance rate to other types of antibiotics was not high.Conclusions Hunan Province has shown a stable trend. Summer and autumn are the high incidence seasons. The serotypes are mainly Salmonella typhimurium and Salmonella enteritis. The clinical manifestations are mainly fever and diarrhea. The preferred antibiotics for treatment are imipenem, azithromycin, amikacin, piperacillin/tazobactam, etc.