昆明地区儿童肠道细菌感染特点及耐药性分析

Analysis of the characteristics and drug-resistance of childhood intestinal bacterial infection in Kunming area

目的分析儿童肠道细菌感染及耐药情况,为细菌性肠炎的合理用药治疗提供参考。方法收集昆明市儿童医院2014年1月至2022年12月门急诊和住院部收治的腹泻患儿,且粪便标本培养检出致病菌的病例,对致病菌耐药情况进行统计分析。结果检测粪便标本的腹泻患儿10233例,经粪便培养检出致病菌595例,检出率5.8%,其中,沙门菌属检出456例,占76.6%。志贺菌属128例,占21.5%,其中以福氏志贺菌为主(58.6%)。科室分布以消化内科最多,其次是感染科病房。季节分布以夏秋季高发,年龄分布以3岁以下婴幼儿期为高发,且以幼儿期病例数最多。药敏结果显示:沙门菌、志贺菌对青霉素类、氨基糖苷类具有较高的耐药性,对阿莫西林/克拉维酸、喹诺酮类、碳青霉烯类高度敏感;头孢菌素类对沙门菌具有较好的抗菌活性,耐药率12.9%~32.7%,但沙门菌对头孢曲松、头孢他啶的耐药率总体呈上升趋势;头孢他啶和头孢吡肟对志贺菌具有较好的抗菌活性,但志贺菌对头孢曲松的耐药率高达95.0%。结论昆明地区细菌感染性腹泻致病菌以沙门菌属为主,以3岁以下婴幼儿期感染最多。沙门菌属对头孢曲松的耐药率呈上升趋势,对阿莫西林/克拉维酸、喹诺酮类、碳青霉烯类高度敏感,可为基层临床儿科医师在无法获取细菌培养药敏结果时,提供符合地方特点的用药参考。

Objective To analyze the situation of intestinal bacterial infections and drug resistance in children,and provide reference for the rational use of drugs in the treatment of bacterial enteritis.Methods We collected cases of diarrhea in children admitted to the outpatient and inpatient departments of Kunming Children's Hospital from January 2014 to December 2022,whose fecal samples was detected pathogenic bacteria.The drug resistance of pathogenic bacteria was analyzed.Results A total of 10233 children with diarrhea were tested for fecal samples,and 595 cases of pathogenic bacteria were detected through fecal culture,with a detection rate of 5.8%.Among them,456 cases of Salmonella were detected,accounting for 76.6%.There were 128(21.5%)cases of Shigella genus,of which Shigella flexneri was the main subset(58.6%).The distribution of departments was most common in the gastroenterology department,followed by the infectious disease wards.The seasonal distribution of bacterial enteritis showed that the incidence was high in summer and autumn.Infants and young children under three years old was found have the highest incidence.The drug sensitivity results showed that Salmonella and Shigella had high resistance to penicillin and aminoglycosides,and were highly sensitive to amoxicillin/clavulanic acid,quinolones,and carbapenems;Cephalosporins had good antibacterial activity against Salmonella,with a resistance rate of 12.9%to 32.7%.However,the overall resistance rate of Salmonella to ceftriaxone and ceftazidime was on the rise.Cefotaxime and cefepime had good antibacterial activity against Shigella,but Shigella had a high resistance rate of 95.0%to ceftriaxone.Conclusion Salmonella is the main pathogen causing bacterial diarrhea in Kunming region,with the highest incidence in infants and young children under the age of three.The resistance rate of Salmonella to ceftriaxone is on the rise,and it is highly sensitive to amoxicillin/clavulanic acid,quinolones,and carbapenems.This can provide local medication references for primary clinical pediatricians when they cannot obtain the results of bacterial culture drug sensitivity.