宏基因组二代测序技术在鉴别儿童肠道病原菌与耐药菌中的应用研究

Application of metagenomic second-generation sequencing technology in the identification of intestinal pathogens and drug-resistant bacteria in children

目的:研究宏基因组二代测序技术在鉴别儿童肠道病原菌与耐药菌中的临床应用价值。方法:选取2020年10月至2022年5月郴州市第一人民医院收治的600例腹泻患儿,连续采集其自住院第一天起至出院期间每天的粪便标本,并尽量采集其痊愈出院后的粪便一次,以便于进行连续观察。以宏基因组二代测序技术对患儿的标本进行检测,并对其进行药敏试验。统计分析粪便培养和药敏试验的结果。结果:600例腹泻患儿的粪便标本中共分离出病原菌52株,检出率为8.67%。其中主要病原菌有志贺菌属(8株)、大肠埃希菌(6株)、沙门菌属(6株)、变形杆菌属(6株)、肠球菌属(6株)。药敏试验显示,以上5种主要病原菌对亚胺培南的耐药性最低,其次是头孢哌酮、哌拉西林他唑巴坦。结论:借助宏基因组二代测序技术在儿童肠道病原菌检测中发现儿童感染性腹泻病原菌以革兰阴性菌为主,临床治疗时应合理使用抗生素,避免产生耐药性。

Objective:To study the clinical application value of metagenomic second-generation sequencing technology in the identification of intestinal pathogens and drug-resistant bacteria in children.Methods:600 children with diarrhea admitted to the First People’s Hospital of Chenzhou City from October 2020 to May 2022 were collected from the first day of hospitalization to the period of discharge,and feces were collected once after recovery and discharge as far as possible for continuous observation.Metagenomic second generation sequencing technology was used to detect the samples of the children,and the drug sensitivity test was conducted.The results of fecal culture and drug sensitivity test were analyzed statistically.Results:A total of 52 strains of pathogenic bacteria were isolated from stool samples of 600 children with diarrhea,the detection rate was 8.67%.The main pathogenic bacteria were Shigella(8 strains),Escherichia coli(6 strains),Salmonella(6 strains),Proteus(6 strains),Enterococcus(6 strains).The drug susceptibility test showed that the resistance to imipenem was the lowest among the above 5 main pathogens,followed by cefoperazone and piperacillin tazobactam.Conclusions:In the detection of intestinal pathogens in children by metagenomic second-generation sequencing technology,Gram-negative bacteria were found to be the main pathogens of infectious diarrhea in children.Antibiotics should be used rationally in clinical treatment to avoid drug resistance.