小儿细菌性痢疾147例志贺菌菌型及耐药性分析  

Analysis of Distribution and Antibiotic Resistance of 147 Strains of Shigella in Children with Bacillary Dysentery

作　　者：蒋鸿超[1] 黄海林[1] 苏敏[1] 奎莉越[1] 寸树兰[1] 温柏平[1] 

机构地区：[1]昆明医科大学附属儿童医院,云南昆明650000

出　　处：《儿科药学杂志》2013年第2期43-46,共4页Journal of Pediatric Pharmacy

摘　　要：目的:探讨昆明地区儿童志贺菌感染菌型分布及耐药情况,为指导临床合理应用抗生素提供依据,提高治疗效果,降低患儿病死率。方法:收集2008年1月至2011年12月检测的11 173例患儿粪便培养标本,通过诊断凝集血清分型并培养鉴定细菌菌型,采用K-B纸片法对志贺菌进行常用抗生素的敏感性检测。使用WHONET 5.4软件对原始数据进行分析和统计学处理。结果:11 173例标本共培养分离出志贺菌属147株(1.32%)。2008年至2011年分别检出志贺菌22株(0.99%)、31株(1.08%)、43株(1.43%)和51株(1.64%),检出率逐年上升。分离出的志贺菌分型显示福氏志贺菌占80.3%(F2a、F2b、F4c分别占61.9%、14.3%、4.1%),宋内志贺菌占15.8%,鲍氏志贺菌占2.6%,痢疾志贺菌占1.3%。药敏分析发现志贺菌对氨苄西林普遍耐药,对头孢噻肟、头孢曲松和头孢哌酮的耐药率较高(分别为70.7%、68.7%和63.9%),对头孢他啶、头孢吡肟耐药率较低(分别为13.6%和25.9%)。志贺菌存在较严重的多重耐药现象,最常见为针对氨苄西林、头孢曲松、头孢噻肟的多重耐药(51%),其次为针对氨苄西林、头孢曲松、头孢哌酮的多重耐药(43%)。结论:小儿细菌性痢疾志贺菌具有较高的交叉耐药和多重耐药性,特别是对第三代头孢菌素耐药率较高并且呈现逐年上升趋势,故应加强监测本地区志贺菌耐药情况以有效地控制耐药株的播散流行和产酶株的蔓延。Objective： To investigate distribution and antibiotic resistance of Shigella group in children within Kunming area in recent years for the guidance of clinical treatment, prevention and control of bacillary dysentery. Methods： From 2008 to 2011, total 11,173 cases of fecal specimens in our hospital patients were detected. One hundred and forty seven Suspicious strains isolated from Shigella and Salmonella agar culture were identified to the group by VITEK-32 instrument and serum agglutination of bacteria. K-B method was used to study the antimicrobial resistance. Data and statistical processing were analyzed by WHONET 5.4 software. Results ： From 2008 to 2011, the total infection rate （ 147/11,173 ） was 1.3？.%. In 2008, 2009, 2010, and 2011, among 147 strains of Shigella isolated, the infection rate was 0.99%, 1.08%, 1.43% , and 1.68% , respectively. We find that the infection rate increased steadily year by year. The most common group was S. flexneri （accounting for 80. 3%. F2a, F2b, F4c accounting for 61. 9% , 14. 3% , 4. 1% respectively. ）, followed by S. sonnei （ 15. 8% ）, S. boydii （2. 6% ） and S. dysenteriae （ 1. 3% ）. The results of antibiotic susceptibility test of shigella in vitro showed the general resistance to ampicillin. The resistance rates to cefotaxime, ceftriaxone and cefoperazone were very high （70.7% , 68.7% and 613.9% respectively） , while the resistance rates to ceftazidime and cefepime were relatively low （ 13.6% and 25.9% respectively）. In addition, no isolate was resistant to imipenem. Shigella were tested for multiresistance to cefotaxime, ceftriaxone and ampicillin （51%）, followed by ampicillin, ceftriaxone and cefoperazone （43%）. Conclusions： Due to the multi-resistance and cross-resistance rates to antibiotics （especially the third generation cephalosporin ） increasing steadily year by year in children with bacillary dysentery, it is urgent to strengthen the regular surveillance of antimicrobial susceptibility of Shigella and monitor d

关 键 词：细菌性痢疾 志贺菌 药敏试验 儿童 菌型 

分 类 号：R725.1[医药卫生—儿科]