2018~2020年西安地区儿童食源性腹泻病病原菌分布特征和耐药性及鼠伤寒沙门菌聚类分析  

Analysis of Pathogen Distribution and Drug Resistance of Food-Borne Diarrhea in Children of Xi’an Area from 2018 to 2020

作　　者：王维[1] 王林[2] WANG Wei;WANG Lin(Department of Laboratory Medicine,Xi’an Children Hospital,Xi’an 710003,China;Department of Laboratory Medicine,Xi’an NO.1 Hospital,Xi’an 710002,China)

机构地区：[1]西安市儿童医院检验科,西安710003 [2]西安市第一医院检验科,西安710002

出　　处：《现代检验医学杂志》2021年第4期51-54,80,共5页Journal of Modern Laboratory Medicine

基　　金：陕西省重点研发计划(编号:2017SF-119)。

摘　　要：目的研究西安地区儿童食源性腹泻病流行病学特点、病原菌分布及耐药情况,为预防和治疗儿童食源性疾病提供依据。方法收集西安市儿童医院2018年8月~2020年8月门诊及住院食源性腹泻病患儿粪便标本进行细菌培养,分离的致病菌行基质辅助激光解吸/电离飞行时间质谱(matrix assisted laser desorption ionization-time of flight mass spectroscopy,MALDI-TOF MS)鉴定聚类分析、血清学鉴定及药物敏感性试验。结合临床病例对阳性结果患儿的年龄分布、患病季节性差异、病原菌血清学分布、耐药情况及同源性进行回顾性分析。结果食源性腹泻病患儿送检粪标本1435例,致病菌阳性标本117例,阳性分离率8.15%,其中检出较多的是沙门菌,占90.60%(106/117),鼠伤寒沙门菌50.43%(59/117),肠炎沙门菌27.35%(32/117);食源性腹泻病患儿发病主要集中于两个年龄段,其中2岁以下婴幼儿致病菌检出率5.92%(29/490),3~6岁学龄前期儿童致病菌检出率高达12.35%(61/494)。致病菌于夏季(7~9月份)检出率最高13.16%(55/418),其季节性分离率差异有统计学意义(χ^(2)=23.970,P<0.05);儿童分离的沙门菌对三、四代头孢菌素普遍敏感,其中头孢他啶、头孢噻肟、头孢吡肟的耐药率均<25.00%,喹诺酮类中环丙沙星多数表现为中介,比例高达91.55%,儿童常用氨苄西林(88.15%)及复方新诺明(71.36%)耐药率较高;采用质谱聚类分析59株鼠伤寒沙门菌同源情况,发现该院患儿食源性腹泻病分离的鼠伤寒沙门菌主要为两大簇(Ⅰ型和Ⅱ型)及3个亚小簇(Ⅰa,Ⅰb,Ⅱa)。结论儿童食源性腹泻病的主要致病菌为鼠伤寒沙门菌和肠炎沙门菌,夏季3~6岁学龄前期儿童病原菌分离率较高。沙门菌对三、四代头孢菌素敏感率均较高,可针对儿童食源性腹泻病行降阶梯治疗。聚类分析显示该地区的鼠伤寒沙门菌的同源性较低,亲缘关系相对分散。临床及感控部门应高度警惕儿童Objective To study the epidemiological characteristics,pathogen distribution and drug resistance of foodborne diarrhea in children from Xi’an Children’s Hospital,so as to provide basis for the prevention and treatment of foodborne diarrhea in children.Methods Fecal samples of foodborne diarrhoeal disease in Xi’an Children Hospital from 2018 to 2020 were collected for pathogen culture,MALDI-TOF MS dentification,serological identification and drug sensitivity test.The age distribution,seasonal differences,serological distribution and drug resistance of the children with positive results were analyzed retrospectively.Results A total of 1435 cases of foodborne diarrhea were collected through the food-borne disease monitoring and reporting system,and 117 cases were detected pathogenic bacteria,with a positive isolation rate of 8.15%.The detection rate of Salmonella was 90.60%(106/117).Among them,Salmonella typhimurium 50.43%(59/117)and Salmonella enteritis 27.35%(32/117)were more detected.Pathogenic bacteria detection rate was the highest in 3~6 years old group(12.35%),and followed by≤2 years old(5.92%).The detection rate of pathogenic bacteria was the highest in summer(from July to September),which counted 13.16%(55/418),and the difference of seasonal separation rate was statistically significant(χ^(2)=23.970,P<0.05).The drug resistance rates of Salmonella to third and fourth generation cephalosporins were<25%.The intermediary percentage of ciprofloxacin was 91.55%.The drug resistance rates of Salmonella to ampicillin and cotrimoxazole were 88.15%and 71.36%,respectively,and these were commonly used antibiotics in children.Cluster analysis showed that 59 strains of Salmonella typhimurium was divided into two clusters(ⅠandⅡ)and three small clusters(Ⅰa,Ⅰb,Ⅱa).Conclusion The main pathogenic bacteria of foodborne diarrhea in children were Salmonella typhimurium and Salmonella enteritis.In summer,the isolation rate of pathogenic bacteria in preschool children aged 3~6 years was relatively high.The drug r

关 键 词：食源性腹疾病 儿童腹泻 沙门氏菌 耐药性 同源性 

分 类 号：R378.22[医药卫生—病原生物学] R446.5[医药卫生—基础医学]