2008—2021年四川省腹泻病例中志贺氏菌分布特征和耐药分析

Distribution characteristics and drug resistance of shigella isolates from diarrhea patients in Sichuan Province from 2008 to 2021

目的 分析2008—2021年四川省腹泻患者分离的志贺氏菌分布特征和耐药趋势。方法 对2008—2021年腹泻病例中分离的207株志贺氏菌进行鉴定、血清分型并采用微量肉汤稀释法进行药敏试验,对药敏试验MIC结果采用MannWhitney U检验进行差异性分析,检验水准为α=0.05。结果 207例病例以学龄前儿童为主,占总病例数的49.32%。福氏志贺氏菌、宋内氏志贺氏菌、痢疾志贺氏菌分别为164株、42株和1株,最常见的血清型为福氏志贺氏菌2a型,占比53.62%。志贺氏菌分离菌株对萘啶酸、氨苄西林、四环素和复方新诺明的耐药率达到了90%以上;对头孢他啶、头孢西丁、亚胺培南、多粘菌素耐药率在10%以下。97.10%的志贺氏菌耐受3种以上的药物,一半以上的菌株耐受7种及以上药物。福氏志贺氏菌与宋内氏志贺氏菌的耐药谱存在差异。福氏志贺氏菌对环丙沙星、氯霉素等6种药物的耐受性高于宋内氏志贺氏菌,而宋内氏志贺氏菌对阿奇霉素、头孢噻肟等4类药物的耐受性较高。近年分离的志贺氏菌株对阿奇霉素、环丙沙星的最低抑菌浓度均有升高。结论 四川省志贺氏菌耐药性形势严峻,多重耐药现象严重。四川省不同志贺氏菌耐药谱存在显著差异,需要根据志贺氏菌型别或耐药谱制定针对性的治疗方案。

Objective To analyze the distribution characteristics and drug resistance of Shigella from diarrhea patients in Sichuan province from 2008 to 2021.Methods The 207 strains of Shigella isolated from diarrhea cases were identified,serotyped and tested for drug susceptibility by micro-broth dilution method.The difference analysis of MIC results of drug sensitivity test was performed by Mann-Whitney U test,and the test level wasα=0.05.Results The majority of the 207 cases were preschool children,accounting for 49.32%of the total cases.There were 164 strains,42 strains and 1 strain of S.flexneri,S.sonnei and S.dysenteriae,respectively.And the most common serotype was S.flexneri serotype 2a,accounting for 53.62%.The resistance rate of Shigella isolates to nalidixic acid,ampicillin,tetracycline and trimethoprim/sulfamethoxazole reached more than 90%;The resistance rate to ceftazidime,cefoxitin,imipenem and colistin was less than 10%.And 97.10%of Shigella isolates were resistant to three or more drugs,and more than half of the isolates were resistant to seven drugs or more.There were differences in the drug resistance spectrum between S.flexneri and S.sonnei.The tolerance of S.flexneri isolates to 6 drugs such as ciprofloxacin and chloramphenicol was higher,while that of S.sonnei was higher to 4 drugs including azithromycin and cefotaxime.By comparing the resistance of Shigella isolates in different years,it was found that the resistance rates of isolates to azithromycin and ciprofloxacin was increasing in recent years.Conclusions It is severe that drug resistance situation of Shigella in Sichuan,and multidrug resistance strains are widely distributed.There are differences in the resistance spectrum between various kinds of Shigella in Sichuan province,and targeted treatment plans need to be formulated according to the Shigella serotype or drug resistance spectrum.