93例儿童鼠伤寒沙门菌多位点序列分型与临床特征及耐药相关性分析  

Multilocus sequence typing, clinical characteristic, and drug resistance of Salmonella typhimurium in 93 children

作　　者：张睿 陈惠瑜[3] 叶红[1,2] Zhang Rui;Chen Huiyu;Ye Hong(Department of Digestive and Nutrition,Fujian Children′s Hospital(Fujian Branch of Shanghai Children′s Medical Center),Fuzhou 350011,China;College of Clinical Medicine for Obstetrics&Gynecology and Pediatrics,Fujian Medical University,Fuzhou 350001,China;Department of Clinical Laboratory,Fujian Maternity and Child Health Hospital,Fuzhou 350001,China)

机构地区：[1]福建省儿童医院(上海儿童医学中心福建医院)消化营养科,福州350011 [2]福建医科大学妇儿临床医学院,福州350001 [3]福建省妇幼保健院检验科,福州350001

出　　处：《中华实用儿科临床杂志》2023年第7期510-514,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：福建省卫健委中青年骨干人才培养项目(2019-ZQNB-15)。

摘　　要：目的了解儿童鼠伤寒沙门菌多位点序列分型(MLST分型)、临床特征及耐药特性, 为儿童鼠伤寒沙门菌感染诊治提供参考。方法回顾性收集2017年11月至2020年10月福建省妇幼保健院经粪便或血培养确诊鼠伤寒患儿的临床信息, 并对样本中分离的鼠伤寒沙门菌进行MLST分型及药敏试验。使用Kruskal-Wallis检验、χ^(2)检验、Fisher′s精确概率法进行统计学分析。结果 96例患儿分离出鼠伤寒沙门菌, 有效病例93例。其中92例来自粪便培养, 1例来自血培养;男53例(56.99%), 女40例(43.01%);发病年龄主要集中在12.0(8.5, 22.0)月龄, 7月至10月是发病高峰。按MLST分型将患儿分为ST34型(58例)、ST19型(22例)及其他型(13例)。不同MLST分型鼠伤寒沙门菌感染后引起呼吸道症状差异有统计学意义(χ^(2)=17.657, P<0.001), ST34型鼠伤寒沙门菌肠炎者更常伴有呼吸道症状(Cramer V=0.421, P<0.001)。药敏试验:不同MLST分型对氨苄西林(χ^(2)=8.774, P=0.033)、哌拉西林他唑巴坦(χ^(2)=6.713, P=0.022)、环丙沙星(χ^(2)=20.780, P<0.001)、磺胺甲唑(χ^(2)=15.364, P=0.001)、氨苄西林舒巴坦(χ^(2)=17.626, P=0.001)及左氧氟沙星(χ^(2)=25.648, P<0.001)的敏感性比较差异均有统计学意义。对头孢曲松(χ^(2)=1.027, P=0.621)、头孢他啶(χ^(2)=7.637, P=0.059)、头孢吡肟(χ^(2)=6.099, P=0.116)及头孢哌酮舒巴坦(χ^(2)=2.405, P=0.649)敏感性比较差异均无统计学意义。所有菌株对亚胺培南及美罗培南敏感。结论婴幼儿是儿童鼠伤寒沙门菌感染的主要人群, 7月至10月是发病高峰, 鼠伤寒沙门菌MLST分型以ST34型为主且更常伴有呼吸道症状;应参照药物敏感性选择抗生素, 无药敏试验结果可经验性选择三代头孢菌素。Objective To investigate the multilocus sequence typing(MLST),clinical manifestations,and drug resistance of Salmonella typhimurium in children,thus providing references for the diagnosis,treatment,and prevention of pediatric Salmonella typhimurium infection.Methods The clinical data of patients with Salmonella typhimurium serotypes confirmed by stool or blood culture between November 2017 and October 2020 were retrospectively collected from Fujian Maternity and Child Health Hospital.MSLT and drug susceptibility test were performed on Salmonella typhimurium isolated from the samples.Kruskal-Wallis test,Chi-square test,and Fisher′s exact probability method were employed for data analyses.Results Salmonella typhimurium was cultured from clinical samples of 96 children,of which,93 samples were effective,including 92 stool samples and 1 blood sample from 53 boys(56.99%)and 40 girls(43.01%).The median age of disease onset occurred at 12.0(8.5-22.0)months,with peak months of onset ranging from July to October.According to MLST classification,93 children were divided into ST34 classification(n=58),ST19 classification(n=22)and other classification(n=13).Respiratory symptoms were significant different among MLST classification,and ST34 type Salmonella typhimurium enteritis was more commonly accompanied by respiratory symptoms(χ^(2)=17.657,P<0.001;Cramer V=0.421,P<0.001).There were significant differences in the drug sensitivity to Ampicillin(χ^(2)=8.774,P=0.033),Piperacillin tazobactam(χ^(2)=6.713,P=0.022),Ciprofloxacin(χ^(2)=20.780,P<0.001),Sulfamethoxazole(χ^(2)=15.364,P=0.001),Ampicillin sulbactam(χ^(2)=17.626,P=0.001)and Levofloxacin(χ^(2)=25.648,P<0.001)among 3 groups.No significant difference was found in the sensitivity to Ceftriaxone(χ^(2)=1.027,P=0.621),Ceftazidime(χ^(2)=7.637,P=0.059),Cefepime(χ^(2)=6.099,P=0.116)and Cefoperazone/Sulbactam(χ^(2)=2.405,P=0.649).All MLST types were sensitive to Imipenem and Meropenem.Conclusions Salmonella typhimurium infection mainly affects infants,with the peak mon

关 键 词：鼠伤寒沙门菌 多位点序列分型 抗生素耐药性 

分 类 号：R725.1[医药卫生—儿科]