深圳市急性感染性腹泻病人来源沙门菌监测情况  

Surveillance of Salmonella from patients with acute infectious diarrhea in Shenzhen city

作　　者：陈浩川 张金金[1] 吴炫桢 许玉成[1] 欧泳萱 申红卫[1,3] CHEN Hao-chuan;ZHANG Jin-jin;WU Xuan-zhen;XU Yu-cheng;OU Yong-xuan;SHEN Hong-wei(Futian District Center for Disease Control and Prevention,Shenzhen,Guangdong 518040;Shenzhen Futian District Cadre Health Center,Shenzhen,Guangdong 518048;Shenzhen Hospital,Southern Medical University,Shenzhen,Guangdong 518110,China)

机构地区：[1]深圳市福田区疾病预防控制中心,广东深圳518040 [2]深圳市福田区干部保健中心,广东深圳518048 [3]南方医科大学深圳医院,广东深圳518110

出　　处：《热带医学杂志》2021年第3期377-381,共5页Journal of Tropical Medicine

基　　金：广东省自然科学基金(2020A1515010008);福田区卫生公益性科研项目(FTWS2019067,FTWS2019073);南方医科大学深圳医院国自然培育计划(PY2020YM02);2020年南方医科大学深圳医院重点学科建设基金科研提升计划(ZDXKKYTS007);2020年深圳市宝安区医疗卫生基础研究项目(2020JD437)。

摘　　要：目的了解深圳地区沙门菌的感染率、血清学分布和耐药性特征,为制定防控措施提供依据。方法选择3家哨点医院(北京大学深圳医院、深圳市儿童医院、中山大学附属第八医院),对2016-2018年肠道门诊急性腹泻患者粪便标本分离的沙门菌进行血清分型、抗生素敏感性试验和耐药基因gyrA、gyrB、parC、parE的检测。结果从2842例腹泻患者的粪便标本中分离出187株(6.6%)沙门菌,共鉴定出25种血清型,其中鼠伤寒沙门菌的分离率最高(3.5%),其次为肠炎沙门菌(1.3%)、4,5,12:i:-(0.3%)。沙门菌对氨苄西林、磺胺甲恶唑/甲氧苄啶、萘啶酸的耐药率较高,分别为81.0%、36.0%、31.0%。肠炎沙门菌和4,5,12:i:-分别对萘啶酸和氨苄西林全部耐药;鼠伤寒沙门菌和4,5,12:i:-对头孢菌素类、环丙沙星、左氧氟沙星和磺胺甲恶唑/甲氧苄啶耐药率较高。所有环丙沙星/左氧氟沙星耐药菌株的gyrA基因均发现突变,而gyrB、parC、parE基因均未发生突变。结论鼠伤寒沙门菌和肠炎沙门菌是深圳地区流行的最常见血清型,鼠伤寒沙门菌对抗生素的耐药率较高。氟喹诺酮耐药可能与gyrA基因突变有关,建议临床合理使用抗生素,并对本地区沙门菌的流行状况进行持续监测。Objective To understand the infection rate,serological distribution and drug resistance characteristics of Salmonella in Shenzhen area,and provide a basis for formulating prevention and control measures.Method Three sentinel hospitals were selected to perform serotyping,antibiotic susceptibility tests,and drug resistance genes gyrA,gyrB,parC,and parE analysis on Salmonella isolated from stool samples of patients with acute diarrhea in the intestinal outpatient clinic from 2016 to 2018.Results 187 strains(6.6%)of Salmonella were isolated from stool specimens of 2842 patients with diarrhea,and 25 serotypes were identified.Among them,Salmonella typhimurium had the highest isolation rate(3.5%),followed by Salmonella enteritidis(1.3%)and 4,5,12:i:-(0.3%).Salmonella resistance rates to ampicillin,sulfamethoxazole/trimethoprim(SXT),and nalidixic acid,were 81.0%,36.0%,and 31.0%,respectively.Salmonella enteritidis and 4,5,12:i:-were all resistant to nalidixic acid and ampicillin,respectively.A high resistance to cephems,ciprofloxacin(CIP),levofloxacin(LEV),and SXT was found in Salmonella typhimurium and 4,5,12:i:-isolates.Mutation in gyrA gene was found in all of the CIP/LEV-resistant isolates,but no mutation was observed in gyrB,parC,or parE gene.Conclusions Salmonella typhimurium and Salmonella enteritidis were the most common serotypes circulating in Shenzhen,and Salmonella typhimurium had a high resistance rate to antibiotics.Fluoroquinolone resistance might be related to gyrA gene mutations.Antibiotics should be used rationally in clinical practice and the epidemic status of Salmonella in this area should be continuously monitored.

关 键 词：沙门菌 血清型 耐药性 腹泻 

分 类 号：R378.22[医药卫生—病原生物学]