浙江省儿童侵袭性沙门菌感染临床和微生物学特点的双中心研究  

Dual-center study of the clinical and microbiological characteristics of invasive Salmonella infection in children in Zhejiang Province

作　　者：沈珑慧 鲁成刚 华春珍[2] 何娟妃 罗巧二 Shen Longhui;Lu Chenggang;Hua Chunzhen;He Juanfei;Luo Qiaoer(Department of Pharmacy,Women and Children′s Hospital of Ningbo University,Ningbo 315010,China;Department of Infectious Diseases,Children′s Hospital Zhejiang University School of Medicine,Hangzhou 310052,China;Department of Medical Laboratory,Women and Children′s Hospital of Ningbo University,Ningbo 315010,China;Department of Rehabilitation,Women and Children′s Hospital of Ningbo University,Ningbo 315010,China)

机构地区：[1]宁波大学附属妇女儿童医院药剂科,宁波315010 [2]浙江大学医学院附属儿童医院感染科,杭州310052 [3]宁波大学附属妇女儿童医院检验科,宁波315010 [4]宁波大学附属妇女儿童医院康复科,宁波315010

出　　处：《中华传染病杂志》2024年第9期538-543,共6页Chinese Journal of Infectious Diseases

基　　金：宁波市医疗卫生高端团队重大攻坚项目(2022020405)。

摘　　要：目的研究儿童侵袭性沙门菌感染的临床特点和微生物学特征。方法回顾性分析2018年1月至2022年6月浙江大学医学院附属儿童医院和宁波大学附属妇女儿童医院收治的侵袭性沙门菌感染患儿的临床资料,检测病原菌的血清型和耐药性。不同血清群沙门菌对抗菌药物的耐药率比较采用χ^(2)检验。结果共纳入侵袭性沙门菌感染患儿105例,年龄为20.0(12.3,43.5)个月,其中男67例(63.8%)。57例患儿于夏季(6月至8月)发病。87例经血培养确诊,10例经骨髓或骨髓腔脓液培养确诊,6例经脑脊液等其他标本培养确诊,另有2例患儿同时从2种标本(血液、骨髓或脑脊液)中培养到沙门菌。36例有基础疾病,其中21例(58.3%)为白血病。菌株对氨苄西林、头孢曲松、头孢他啶、哌拉西林-他唑巴坦、亚胺培南和甲氧苄啶-磺胺甲噁唑的耐药率分别为48.5%(51/105)、12.3%(13/105)、9.5%(10/105)、1.9%(2/105)、0(0/105)和29.5%(31/105)。侵袭性非伤寒沙门菌(iNTS)99株(94.3%),伤寒沙门菌仅4株,鼠伤寒沙门菌13株。D群菌株对头孢曲松的耐药率低于B群(χ^(2)=5.38,P=0.020)和E群(χ^(2)=5.74,P=0.017);其对甲氧苄啶-磺胺甲噁唑的耐药率低于C群(χ^(2)=5.67,P=0.017)、B群(χ^(2)=13.02,P<0.001)和E群(χ^(2)=9.00,P=0.003),差异均有统计学意义。临床症状中,发热99例(94.3%),腹泻54例(51.4%)。疾病诊断中,败血症最为常见[93例(88.6%)],化脓性骨髓炎伴化脓性关节炎11例(10.5%),4例(3.8%)发展为化脓性脑膜炎。105例患者均接受抗菌药物治疗,101例(96.2%)治愈好转,4例(3.8%)死亡。结论儿童iNTS感染比伤寒更为常见。不同血清型的菌株对抗菌药物的耐药性存在差异。血流等侵袭性菌株对第三代头孢菌素较敏感,第三代头孢菌素仍是治疗本病的首选用药。Objective To study the clinical and microbiological characteristics of invasive Salmonella infection in children.MethodsClinical data of children with invasive Salmonella infection diagnosed in the Children′s Hospital Zhejiang University School of Medicine and Women and Children′s Hospital of Ningbo University from January 2018 to June 2022 were retrospectively analyzed,and the serotypes and drug resistance of the pathogens were detected.The chi-square test was used to compare the resistance rates of different Salmonella serogroups to antibiotics.ResultsA total of 105 invasive Salmonella infection cases were included,with ages of 20.0(12.3,43.5)months,and 67 cases(63.8%)were male.Fifty-seven cases occurred in summer(from June to August).Eighty-seven cases were confirmed by blood culture,10 cases by bone marrow or bone marrow cavity pus culture,six cases by cerebrospinal fluid and other specimen culture,with an additional two cases where Salmonella was cultured from two types of specimens including blood,bone marrow or cerebrospinal fluid.Thirty-six patients had underlying diseases,of which 58.3%(21/36)were leukemia.The resistance rates of the strains to ampicillin,ceftriaxone,ceftazidime,piperacillin-tazobactam,imipenem,and trimethoprim-sulfamethoxazole were 48.5%(51/105),12.3%(13/105),9.5%(10/105),1.9%(2/105),0(0/105),and 29.5%(31/105),respectively.Ninety-nine strains(94.3%)belonged to invasive non-typhoidal Salmonella(iNTS),four strains were Salmonella typhi,and 13 strains were Salmonella typhimurium.The resistance rate of group D strains to ceftriaxone was lower than that of group B(χ^(2)=5.38,P=0.020)and group E(χ^(2)=5.74,P=0.017).The resistance rate of group D strains to trimethoprim-sulfamethoxazole was lower than that of group C(χ^(2)=5.67,P=0.017),group B(χ^(2)=13.02,P<0.001)and group E(χ^(2)=9.00,P=0.003),and the differences were all statistically significant.The symptoms of fever and diarrhea accounted for 94.3%(99/105)and 51.4%(54/105),respectively.The most common diagnosis was septicemia,acc

关 键 词：儿童 沙门氏菌 侵袭性感染 抗菌药物耐药性 血清型 

分 类 号：R516.3[医药卫生—内科学]