上海市鼠伤寒沙门菌单相变异株的鉴定和耐药谱分析  

Identification and antimicrobial susceptibility of Salmonella typhimurium monophasic variant in Shanghai

作　　者：吴雯[1] 屠丽红[1] 张雯霞[2] 张曦[1] 陈敏[1] WU Wen;TU Lihong;ZHANG Wenxia;ZHANG Xi;CHEN Min(Shanghai Municipal Center for Disease Control and Prevention,Shanghai 200336,China;Department of Clinical Laboratory,Shuguang Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China)

机构地区：[1]上海市疾病预防控制中心,上海200336 [2]上海中医药大学附属曙光医院检验科,上海201203

出　　处：《检验医学》2018年第9期798-802,共5页Laboratory Medicine

基　　金：上海市卫生和计划生育委员会资助项目(20144Y0062);上海市第四轮公共卫生三年行动计划高端海外研修团队培养计划(GWTD2015S01);十三五国家传染病防治科技重大专项(2017ZX10103009-003)

摘　　要：目的了解2013—2015年上海市流行的鼠伤寒沙门菌单相变异株的基因型和耐药谱。方法对2013—2015年上海市疾病预防控制中心细菌检测实验室保存的1 179株分离自腹泻患者的沙门菌进行血清分型复核,结合聚合酶链反应(PCR)筛选、鉴定鼠伤寒沙门菌单相变异株。采用PCR检测鼠伤寒沙门菌单相变异株基因型。采用改良纸片扩散法对鼠伤寒沙门菌双相株和单相株进行14种抗菌药物体外药物敏感性试验,参考美国临床实验室标准化协会(CLSI)标准判断结果。结果 1 179株沙门菌中共检出鼠伤寒沙门菌单相变异株52株,在沙门菌和鼠伤寒沙门菌中的阳性率分别为4.4%和23.3%,病例来源主要为上海郊区,且以青中年人群为主。在52株鼠伤寒沙门菌单相变异株中,有44株(84.6%)fljB基因缺失;在8株fljB基因未缺失株中,有2株(3.8%)基因型为fljB+fljA-hin-,6株(11.6%)为fljB+fljA+hin+。药物敏感性试验结果显示,耐3类以上抗菌药物的单相株有40株(76.9%),耐4类以上抗菌药物的单相株有36株(69.2%),并且鼠伤寒沙门菌单相株对氨苄西林-链霉素-磺胺类药-四环素(ASSu T)的耐药率(61.54%)和对氨苄西林-氯霉素-链霉素-磺胺类药-四环素(ACSSu T)的耐药率(19.23%)均远高于双相株(10.6%)(P<0.05)。结论上海市鼠伤寒沙门菌单相变异株检出率较高且人群分布不均,多重耐药性严重,在疾病防控中应注意合理布局资源和使用药物。Objective To investigate the genotypes and antimicrobial susceptibility of monophasic variant of Salmonella typhimurium(monophasic Salmonella typhimurium)in Shanghai from 2013 to 2015.Methods A total of 1 179 isolates of Salmonella isolated from diarrheal patients from 2013 to 2015 and stored by bacter testing laboratory in Shanghai Municipal Center for Disease Control and Prevention were collected.Serotyping and polymerase chain reaction(PCR)were used to screen and identify monophasic Salmonella typhimurium.The genotype was analyzed by PCR.Antimicrobial susceptibility was evaluated by Kirby-Bauer disk diffusion method with 14 antimicrobial agents for monophasic and diphasic Salmonella typhimurium,in accordance with the Clinical and Laboratory Standards Institute(CLSI)guidelines.Results A total of 52 isolates were identified as monophasic Salmonella typhimurium from 1 179 isolates of Salmonella.The percentages of monophasic Salmonella typhimurium in all isolates of Salmonella and Salmonella typhimurium were 4.4%and 23.3%,respectively.The determination rate of monophasic Salmonella typhimurium was high in young-and middle-aged groups.Most of them were from the suburbs of Shanghai.In the 52 isolates of monophasic Salmonella typhimurium,44 isolates(84.6%)were confirmed as fljB gene positive,and the remaining 8 isolates were fljB+fljA-hin-(2 isolates,3.8%)and fljB+fljA+hin+(6 isolates,11.6%).There were 40 isolates(76.9%)of monophasic Salmonella typhimurium resistant to 3or more antimicrobials.There were 36 isolates(69.2%)resistant to more than 4 antimicrobials.The drug resistance rates to ampicillin-streptomycin-sulfonamide-tetracycline(ASSuT)and ampicillin-chloramphenicol-streptomycinsulfonamide-tetracycline(ACSSuT)were 61.54%and 19.23%,respectively,which were higher than those of diphasic Salmonella typhimurium(P<0.05).Conclusions The determination rate of monophasic Salmonella typhimurium is high in Shanghai with multi-drug resistance and uneven population distribution.It should be paid attention to the reasonable

关 键 词：鼠伤寒沙门菌 耐药性 基因型 单相变异株 

分 类 号：R446.5[医药卫生—诊断学]