北京地区多重耐药的腹泻病原菌的构成及耐药特点  

Composition and Drug Resistance Characteristics of Multidrug-Resistant Diarrhea Pathogens in Beijing Area

作　　者：张成龙 陈素明 张树永 王慧珠 陈铭[4] 张敬霞 曲芬 ZHANG Chenglong;CHEN Suming;ZHANG Shuyong;WANG Huizhu;CHEN Ming;ZHANG Jingxia;QU Fen(Laboratory Medical Center of Aviation General Hospital,Beijing 100021,China;The Center ofClinical Laboratory of the Fifth Medical Center of PLA General Hospital,Beijing 100039,China;Beijing Ditan Hospital Affiliated to Capital Medical University,Beijing 100102,China;Beijing You’an Hospital Affiliated to Capital Medical University Beijing 100069,China)

机构地区：[1]航空总医院,北京100021 [2]解放军总医院第五医学中心临床临检中心,北京100039 [3]首都医科大学附属北京地坛医院,北京100102 [4]首都医科大学附属北京佑安医院,北京100069

出　　处：《标记免疫分析与临床》2023年第4期559-563,共5页Labeled Immunoassays and Clinical Medicine

基　　金：碳青霉烯耐药肠杆菌科的诊断及分子流行病学研究(编号:BS2020-002)。

摘　　要：目的 感染性腹泻是全球性的公共卫生问题,三代头孢菌素(third-generation cephalosporins, TGCs)是严重腹泻患者的首选治疗,监测医院与腹泻有关耐TGCs的腹泻病原菌的增长趋势和耐药特点,为本地区的流行病学研究及临床合理用药提供依据。方法 收集北京地区的传染病医院2011~2020年腹泻患者大便标本进行培养,筛选致病菌经生化及血清学进一步鉴定到种或群,并以纸片扩散法测定抗菌药物的敏感性;分析耐TGCs的腹泻病原菌的特点。结果 10年间共分离出沙门菌、志贺菌、气单胞菌、类志贺毗邻单胞菌、大肠埃希菌和弧菌等腹泻病原菌2 111株,其中268株耐TGCs,占整个肠道致病菌的12.70%,产生率由2011年的2.71%上升至2020年的29.29%,以致泻大肠埃希菌(39.57%)和气单胞菌(21.55%)最高,对四代头孢菌素、氟喹诺酮类、氯霉素、复方新诺明的耐药率在29%~83%,对磷霉素的耐药率最低8.27%。耐TGCs常表现多重耐药,同时耐喹诺酮类、氯霉素、复方新诺明3类抗生素为主。结论 耐TGCs的腹泻病原菌上升迅速,耐药广泛,不同种属的耐药性不同,应加强监测。Objective Infectious diarrhea is a global public health problem,and third-generation cephalosporins(TGCs)are the preferred treatment for severe diarrhea patients.Monitoring the growth trend and drug resistance characteristics of TGCs resistant diarrhea pathogens in hospitals related to diarrhea provides a knowledge basis for epidemiological research and clinical rational drug use in this region.Methods The patient stool samples were collected from diarrhea patients in Beijing Infectious Diseases Hospital from 2011 to 2020.The pathogen bacteria induced diarrhea were cultured and identified to species or group through biochemical and serological test.The susceptibility of bacteria to antimicrobial agents was then tested by Kirby-Bauer(K-B)and the characteristics of diarrhea pathogens resistant to TGCs was analyzed.Results 2111 strains of diarrhea pathogens including Salmonella,Shigella,Aeromonas,Plesiomonas shigelloides,Escherichia coli causing diarrhea and Vibrio were isolated during a 10-year period,of which 268 strains were resistant to TGCs,accounting for 12.70%of the whole diarrhea pathogens.The production rate increased from 2.71%in 2011 to 29.29%in 2020,with Escherichia coli(39.57%)and Aeromonas(21.55%)ranked the top two.The resistance rate of 268 strains to the fourth generation cephalosporins,Cefmetazole,fluoroquinolones and chloramphenicol were 29%-83%,and the resistance rate to fosfomycin was the lowest with 8.27%.Resistance to TGCs manifested as multiple drug resistance,while resistance to quinolones,chloramphenicol,and sulfamethoxazole antibiotics was predominant.Conclusion The diarrhea pathogens resistant to TGCs rises rapidly and have a wide scope of drug resistance.The drug resistance of different species varies,so we should pay attention to a dynamic patient monitoring.

关 键 词：腹泻病原菌 三代头孢菌素耐药 增长 耐药特点 

分 类 号：R378[医药卫生—病原生物学]