2016年江阴市伤寒沙门菌耐药监测及分子分型分析  

Surveillance of antimicrobial resistance and molecular typing of Salmonella typhi in the city of Jiangyin in 2016

作　　者：刘晓骏[1] 姚建香[1] 张宏宾[1] 高海英[1] 周品众[1] 李玲[1] 谢雯 LIU Xiao-jun;YAO Jian-xiang;ZHANG Hong-bin;Gao Hai-ying;ZHOU Pin-zhong;LI Ling;XIE Wen(Jiangyin Center for Disease Control and Prevention,Jiangyin,Jiangsu 214434,China)

机构地区：[1]江阴市疾病预防控制中心

出　　处：《中华医院感染学杂志》2019年第23期3530-3534,共5页Chinese Journal of Nosocomiology

基　　金：国家科技重大专项基金资助项目(2017ZX10103008);无锡市卫生计生委科研基金资助项目(Q201737)

摘　　要：目的分析江阴市2016年伤寒沙门菌的耐药状况及同源性,为伤寒的临床用药和防控提供科学依据。方法按照WS 280-2008《伤寒和副伤寒诊断标准》对江阴市伤寒监测哨点医院的患者进行诊断,按照GB/T 4789.4-2016《食品安全国家标准食品微生物学检验沙门氏菌检验》对患者样本进行分离鉴定。选择10种常见抗菌药物,运用K-B法对从伤寒患者体内分离到的73株伤寒沙门菌进行耐药性试验,并运用脉冲场凝胶电泳(Pulsed Field Gel Eletrophoresis,PFGE)对16株有代表性的伤寒沙门菌进行分子同源性分析。结果江阴市2016年报告伤寒发病率6.56/10万,共分离伤寒沙门菌77株。对73株菌株进行耐药试验,所有菌株对萘啶酸和利福平100.00%耐药,对阿莫西林、头孢噻吩和头孢噻肟100.00%敏感,菌株多重耐药率为39.72%,多重耐药谱为:萘啶酸-利福平-甲氧苄啶。16株菌株经PFGE聚类分析后,呈现4种不同型别,其相似度均>80.00%,其中13株菌株相似度为100.00%。结论江阴市伤寒沙门菌耐药形势严峻,萘啶酸和利福平不再适合用于伤寒治疗,头孢菌素类及青霉素类抗菌药物为孕妇及儿童感染伤寒沙门菌时的首选。PFGE显示13份伤寒菌株与XQ镇井水中分离到的伤寒菌株同源,结合流行病学分析后,确认为暴发菌株。OBJECTIVE To analyze the drug resistance and homology of Salmonella typhi(S.typhi)in Jiangyin in 2016 and provide scientific basis for clinical treatment,prevention and control of S.typhi.METHODS Patients were diagnosed typhoid fever in typhoid surveillance sentinel hospital according to"Diagnostic criteria for typhoid and paratyphoid(WS 280-2008)".Strains of S.typhi were isolated and identified in accordance with"National standard for food safety,food microbiology test for Salmonella test(GB/T 4789.4-2016)".To detect the antimicrobial resistance,10 antibiotics were selected to detect the resistance of 73 strains of S.typhi isolated from typhoid patients by K-B method.Pulse-field gel electrophoresis(PFGE)was performed to distinguish the molecular homology of S.typhi.RESULTS The reported incidence of typhoid fever was 6.56/105 in Jiangyin in 2016.And 77 strains of S.typhi was obtained.After the test of antimicrobial resistance,73 strains of S.typhi were entirely resistant to nalidixic acid and rifampicin(100.00%),and entirely sensitive to amoxicillin,cefalotin and cefotaxime(100.00%).The multi-drug resistant rate of S.typhi was 39.72%,and the multiple antimicrobial resistance profile was nalidixic acid-rifampicin-trimethoprim.According to PFGE clustering analysis,16 strains were clustered into 4 different types,with a similarity over 80.00%,and 13 strains had a similarity of 100.00%.CONCLUSION The antimicrobial resistance of S.typhi is severe in the city of Jiangyin.Nalidixic acid and rifampicin are no longer suitable for the treatment of S.typhi,and cephalosporins and penicillin antibiotics are the first choice for pregnant women and children infected with S.typhi.PFGE results showed that 13 strains of S.typhi were homologous with the S.typhi strain isolated from the well water of XQ town,and were confirmed as the outbreak strains by epidemiological analysis.

关 键 词：伤寒沙门菌 耐药特征 PFGE 分子分型 监测 

分 类 号：R378.22[医药卫生—病原生物学]