社区腹泻病原菌分布特点及耐药性分析  

Distribution characteristics and antibiotic resistance of pathogenic bacteria in community diarrhea

作　　者：陈素明[1] 张树永[1] 张鞠玲[1] 崔恩博[1] 贾天野[1] 鲍春梅[1] 曲芬[1] 

机构地区：[1]解放军第三〇二医院,临床检验医学中心,北京100039

出　　处：《中国抗生素杂志》2017年第7期561-565,共5页Chinese Journal of Antibiotics

基　　金：首都市民健康培育项目(No.Z151100003915151)

摘　　要：目的分析我国部分地区社区获得性腹泻病原菌的分布及抗生素耐药情况,为流行病学调研及临床合理选择抗菌药物治疗提供依据。方法收集2011年1月—2016年12月我国5个地区分离自门诊肠道腹泻患者的粪便标本,分离疑是腹泻病原菌,用VITEKⅡ全自动细菌鉴定仪和微量编码生化反应管鉴定,辅以血清学试验进行血清分型;药敏试验采用K-B纸片扩散法。实验数据采用WHONET 5.6和SPSS 13.0进行统计分析。结果共分离到腹泻病原菌2148株,包括6个属,20个菌种和68个血清型,其中沿海地区433株,以弧菌(42.68%)、气单胞菌(15.42%)和沙门菌(13.70%)为主;内陆地区1715株,以志贺菌(56.36%)的D群宋内志贺菌为主。耐药率较高的抗生素为氨苄西林和复方磺胺甲噁唑;腹泻病原菌对抗生素的耐药性呈曲线上升趋势,并出现多重耐药。结论我国不同地域腹泻病原菌分布存在差异,腹泻病原菌耐药及多重耐药率较高,临床治疗应依据不同腹泻病原菌感染的特点和药敏试验结果合理选择应用抗菌药。Objective To analyze the distribution of pathogens and antibiotic resistance of the community acquired diarrhea in some areas of China in the past six years, and to provide evidence for epidemiologica! investigations and the clinical treatment with reasonable antibiotics. Methods Stool specimens collected from five regions of our country were obtained from outpatients with intestinal diarrhea in 2011-2016. Suspected diarrhea pathogens were identified by VITEK II bacterial identification instrument and trace encoding biochemical reaction tube, and were classified by the serum agglutination test. The K-B diffusion method was used for the antibiotic sensitivity test. The data were analyzed by WHONET 5.6 and SPSS13.0. Results 2,148 strains of pathogenic bacteria were isolated, including 6 genera, 20 species, and 68 serotypes. Among 433 in coastal areas, the main strains were Fibrio （42.68%）, Aeromonas sp. （15.42%）, and Salmonella sp. （13.70%）. Among 1,715 strains from the inland areas, the main strain was Shigella sonnei in the Shigella sp. （56.36%） group. Diarrhea pathogenic bacteria resistant to antibiotics have high rates against ampicillin and cotrimoxazole, the resistance rate of diarrhea pathogens to antibiotics showed an upward trend, and multiple antibiotic resistance. Conclusion There were differences in the distributions of pathogenic bacteria in different regions of China. Diarrhea pathogenic bacteria antibiotic resistance and multi antibiotic resistance rates were high. The clinical treatments should accord with the characteristics of the diarrhea pathogens and the results of antibiotic sensitivity tests.

关 键 词：腹泻 志贺菌属 沙门菌属 弧菌 抗菌药物 

分 类 号：R978.1[医药卫生—药品]