江苏地区儿童尿液中抗生素水平调查及影响因素研究

Urinary antibiotic level and influencing factors in children residing in Jiangsu Province

目的检测儿童体内抗生素的内暴露水平,分析其影响因素。方法2022年6月在江苏省某市问卷调查幼儿园小班和小学一年级儿童,并收集尿样。采用超高效液相色谱-串联质谱法定量检测尿液中41种抗生素。分别采用χ^(2)检验及秩和检验比较抗生素检出率和浓度,Logistic回归分析抗生素检出水平的影响因素。结果研究纳入了江苏地区295名3~8岁儿童。尿液中单一抗生素检出率为0~48.1%,其中磺胺对甲氧嘧啶(48.1%)最高,其次为磺胺嘧啶(38.3%)和红霉素(38.3%)。单一抗生素的95百分位数浓度为0~23.7 ng/mL,其中阿莫西林(23.7 ng/mL)最高,其次为阿奇霉素(6.3 ng/mL)和磺胺嘧啶(3.5 ng/mL)。Logistic回归分析显示年龄、居住地性质、饮用水来源、淡水鱼虾食用频次是特定抗生素暴露的独立影响因素。结论江苏地区儿童尿液中多种抗生素存在不同程度的检出。应关注检出率高和检出浓度高的特定抗生素,针对其影响因素采取干预措施降低儿童的抗生素暴露水平。

Objective To evaluate the internal exposure level of antibiotics in children and analyze its influencing factors.Methods Questionnaires were disseminated and urine samples were collected in June 2022 from kindergarteners and children enrolled in primary schools in a city in Jiangsu Province. The presence of 41 antibiotics was detected in urine using ultra-performance liquid chromatography and tandem mass spectrometry. Chi-square tests and rank-sum tests were performed to test the detection frequencies and concentrations of urinary antibiotics. Logistic regression models were established to identify the independent variables associated with the detection frequencies and concentrations of urinary antibiotics.Results A total of 295 children aged 3-8 from Jiangsu Province were included in this study. The detection frequencies of the antibiotics ranged from 0 to 48. 1%, with sulfameter(48. 1%) having the highest frequency, followed by sulfadiazine(38. 3%) and erythromycin(38. 3%). The 95th percentile concentrations of the antibiotics ranged from 0 to 23. 7 ng/mL, with amoxicillin(23. 7 ng/mL) having the highest concentration, followed by azithromycin(6. 3 ng/mL) and sulfadiazine(3. 5 ng/mL). The results of Logistic regression analysis showed that age, residence, source of drinking water, and freshwater fish and shrimp consumption frequency were identified as independent influencing factors for specific antibiotic exposure.Conclusion Different antibiotics were detected in the urine of children in Jiangsu Province. Intervention measures should be adopted to reduce the exposure of children to antibiotics associated with high detection frequencies and concentrations.