2015-2018年上海市儿童腹泻流行特征及致泻性大肠埃希菌耐药分析
|
摘要
目的了解上海市儿童腹泻流行特征、病原谱及致泻性大肠埃希菌(DEC)的耐药情况。方法收集2015年4月至2018年3月在监测点医院就诊的初诊儿童腹泻病例临床及流行病学资料,同时采集粪便标本进行细菌培养及病毒核酸检测,对分离的DEC进行耐药分析。结果共收集儿童腹泻病例880例,以<5岁幼儿为主(92.95%)。儿童腹泻病例病原检出率为47.50%,且男女性之间差异无统计学意义(χ~2=1.778,P=0.182);0～1岁组病原检出率显著低于其他各年龄组(χ~2=90.929,P<0.001);非母乳喂养儿、混合喂养儿的病原检出率均高于纯母乳喂养儿(χ~2=31.384、14.746,均P<0.001);托幼儿童病原检出率高于散居儿童(χ~2=11.158,P=0.001)。单一病原体的检出,细菌以沙门菌(5.11%)、肠致病性大肠埃希菌(4.55%)、空肠弯曲菌(4.43%)、肠集聚性黏附大肠埃希菌(3.07%)为主;病毒以诺如病毒GⅡ型(7.95%)和轮状病毒A组(4.66%)为主。单纯细菌在≥5岁组检出率最高(35.48%);单纯病毒在3～4岁组检出率最高(28.30%);细菌混合病毒在≥5岁组检出率最高(9.68%)。夏季以细菌为优势病原菌;秋季呈现细菌向病毒过渡状态,细菌混合病毒感染检出率处于全年高峰;冬季以病毒为优势病原。DEC对二、三代头孢菌素头孢噻肟、头孢呋辛、头孢西丁的耐药率分别为15.44%、20.59%、5.88%;对喹诺酮类药物左氧氟沙星、环丙沙星的耐药率均为5.15%。结论托幼儿童病原检出率较高,需引起重视。细菌性腹泻及病毒性腹泻呈现一定的年龄特征及季节性变化。头孢菌素类药物耐药率低于全国水平,但仍需注意合理使用抗生素。
Objective To investigate the epidemiological characteristics and pathogenic spectrum of diarrhea in children in Shanghai, and analyze the drug resistance of diarrheagenic Escherichia coli(DEC). Methods The clinical and epidemiological information of the children who sought medical case in sentinel hospitals due to diarrhea from April 2015 to March 2018 were collected. The stool samples were collected from them for bacterium culture and virus nucleic acid test. The test of drug resistance of the DEC strains was conducted. Results A total of 880 children with diarrhea were surveyed, in whom 92.95% were less than 5 years old. The overall pathogen detection rate was 47.50%. There was no significant difference in pathogen detection rate between boys and girls(χ~2=1.778,P=0.182). The pathogen detection rate was significantly lower in infants less than 1 year old than in other groups(χ~2=90.929,P<0.001). The pathogen detection rate was significantly lower in breastfed infants than in non-breastfed infants and mixed feeding infants(χ~2=31.384,14.746,P<0.001). The pathogen detection rate was higher in children in child care settings than in children outside child care settings(χ~2=11.158,P=0.001).The common bacteria causing diarrhea was Salmonella(5.11%), followed by enteropathogenic E. coli(4.55%), Campylobacter jejuni(4.43%) and enteroaggregative E. coli(3.07%). The common viruses detected were Norovirus GⅡ(7.95%) and rotavirus A(4.66%). The bacteria detection rate was highest in children over 5 years old(35.48%). The virus detection rate was highest in children aged 3–4 years(28.30%). The co-infection rate of bacteria and virus was highest in children aged ≥5 years(9.68%). The predominant pathogen was bacterium in summer and virus in winter. The peak of the detection of co-infection of bacterium and virus was in autumn. The drug resistance rates of DEC to second and third generation cephalosporins of cefotaxime, cefuroxime, cefoxitin were 15.44%, 20.59% and 5.88%, respectively. The drug resistance rates of DEC to quinolones of levofloxacin and ciprofloxacin were all 5.15%. Conclusion Close attention should be paid to children in child care settings since the pathogen detection rate was considerably high. The incidences of bacterial diarrhea and viral diarrhea showed obvious age and seasonal patterns. Although the drug resistance level of DEC to second and third generation cephalosporins was lower than the national level, it is still necessary to use antibiotics rationally.
Objective To investigate the epidemiological characteristics and pathogenic spectrum of diarrhea in children in Shanghai, and analyze the drug resistance of diarrheagenic Escherichia coli(DEC). Methods The clinical and epidemiological information of the children who sought medical case in sentinel hospitals due to diarrhea from April 2015 to March 2018 were collected. The stool samples were collected from them for bacterium culture and virus nucleic acid test. The test of drug resistance of the DEC strains was conducted. Results A total of 880 children with diarrhea were surveyed, in whom 92.95% were less than 5 years old. The overall pathogen detection rate was 47.50%. There was no significant difference in pathogen detection rate between boys and girls(χ~2=1.778,P=0.182). The pathogen detection rate was significantly lower in infants less than 1 year old than in other groups(χ~2=90.929,P<0.001). The pathogen detection rate was significantly lower in breastfed infants than in non-breastfed infants and mixed feeding infants(χ~2=31.384,14.746,P<0.001). The pathogen detection rate was higher in children in child care settings than in children outside child care settings(χ~2=11.158,P=0.001).The common bacteria causing diarrhea was Salmonella(5.11%), followed by enteropathogenic E. coli(4.55%), Campylobacter jejuni(4.43%) and enteroaggregative E. coli(3.07%). The common viruses detected were Norovirus GⅡ(7.95%) and rotavirus A(4.66%). The bacteria detection rate was highest in children over 5 years old(35.48%). The virus detection rate was highest in children aged 3–4 years(28.30%). The co-infection rate of bacteria and virus was highest in children aged ≥5 years(9.68%). The predominant pathogen was bacterium in summer and virus in winter. The peak of the detection of co-infection of bacterium and virus was in autumn. The drug resistance rates of DEC to second and third generation cephalosporins of cefotaxime, cefuroxime, cefoxitin were 15.44%, 20.59% and 5.88%, respectively. The drug resistance rates of DEC to quinolones of levofloxacin and ciprofloxacin were all 5.15%. Conclusion Close attention should be paid to children in child care settings since the pathogen detection rate was considerably high. The incidences of bacterial diarrhea and viral diarrhea showed obvious age and seasonal patterns. Although the drug resistance level of DEC to second and third generation cephalosporins was lower than the national level, it is still necessary to use antibiotics rationally.
引文
[1]WHO.The top 10 causes of death[EB/OL].(2018-05-24)[2018-12-26].https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death.
[2]WHO.Diarrhoeal disease key facts[EB/OL].(2017-05-02)[2018-12-26].https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease.
[3]林玫,董柏青.感染性腹泻流行病学研究现况[J].中国热带医学,2008,8(4):675-677.DOI:10.3969/j.issn.1009-9727.2008.04.078.Lin M,Dong BQ.Status in epidemiological research of infectious diarrhea[J].China Trop Med,2008,8(4):675-677.DOI:10 .3969/j.issn.1009-9727.2008.04.078.
[4]厉小玉,岳美娜,王云桥,等.2008-2012年杭州市儿童感染性腹泻的志贺菌和沙门菌变迁及耐药性分析[J].疾病监测,2014,29(5):364-368.DOI:10.3784/j.issn.1003-9961.2014.05.008.Li XY,Yue MN,Wang YQ,et al.Salmonella and Shigella caused infectious diarrhea in children and pathogens’drug resistance in Hangzhou,Zhejiang,2008-2012[J].Dis Surveill,2014,29(5):364-368.DOI:10.3784/j.issn.1003-9961.2014.05.008.
[5]顾宝柯,袁政安,金汇明,等.上海市沙门菌病流行特征分析[J].环境与职业医学,2008,25(3):245-247,251.DOI:10.3969/j.issn.1006-3617.2008.03.006.Gu BK,Yuan ZA,Jin HM,et al.Epidemiological surveillance of salmonellosis in Shanghai[J].J Environ Occup Med,2008,25(3):245-247,251.DOI:10.3969/j.issn.1006-3617.2008.03.006.
[6]雷蕾,茌静,余光清,等.2012-2014年深圳市宝安区成人和儿童感染性腹泻病原学分析[J].实用预防医学,2016,23(8):934-937.DOI:10.3969/j.issn.1006-3110.2016.08.012.Lei L,Chi J,Yu GQ,et al.Etiological analysis of infectious diarrhea among adults and children in Baoan district,Shenzhen city,2012-2014[J].Prac Prev Med,2016,23(8):934-937.DOI:10.3969/j.issn.1006-3110.2016.08.012.
[7]费怡,孙乔,傅益飞,等.上海市浦东新区5岁以下儿童腹泻病病原谱监测分析[J].上海预防医学杂志,2013(11):602-605.DOI:10.3969/j.issn.1673-6184.2008.03.004.Fei Y,Sun Q,Fu YF,et al.Surveillance and analysis on diarrheal disease pathogen spectrum among children under 5 years old in Pudong new area of Shanghai city[J].Shanghai J Prev Med,2013(11):602-605.DOI:10.3969/j.issn.1673-6184.2008.03.004.
[8]匡建梅,徐全民,王海革,等.青岛市急性腹泻患儿致泻性大肠埃希菌菌型分布和耐药性分析[J].中国妇幼保健,2016,31(19):3956-3958.DOI:10.7620/zgfybj.j.issn.1001-4411.2016.19.30.Kuang JM,Xu QM,Wang HG,et al.Analysis of distribution and drug resistance of diarrheagenic Escherichia coli about children's acute diarrhea in Qingdao[J].Mat Child Health Care China,2016,31(19):3956-3958.DOI:10.7620/zgfybj.j.issn.1001-4411.2016.19.30.
[9]赵嘉咏,朱敏,谢志强,等.河南省5种致泻性大肠埃希菌病原学监测[J].中国病原生物学杂志,2015,10(10):924-927,935.DOI:10.13350/j.cjpb.151014.Zhao JY,Zhu M,Xie ZQ,et al.Etiologic surveillance and study of five types of diarrheagenic Escherichia coli in Henan province[J].J Path Biol,2015,10(10):924-927,935.DOI:10.13350/j.cjpb.151014.
[10]石挺丽,黄建华,李秀芬,等.2014-2015年广州地区腹泻患儿和健康儿童致泻性大肠埃希菌流行特征及耐药分析[J].中华疾病控制杂志,2016,20(4):329-332.DOI:10.16462/j.cnki.zhjbkz.2016.04.002.Shi TL,Huang JH,Li XF,et al.Epidemiological characterization and antimicrobial resistance of diarrhea Escherichia coli from acute diarrheal and healthy children in Guangzhou city,2014-2015[J].Chin J Dis Control Prev,2016,20(4):329-332.DOI:10.16462/j.cnki.zhjbkz.2016.04.002.
[11]胡雪,厉小玉,周俊,等.杭州市腹泻儿童感染致泻性大肠埃希菌的病原学特征分析[J].中国卫生检验杂志,2017,27(22):3299-3300.Hu X,Li XY,Zhou J,et al.Characterization analysis of diarrhea Escherichia coli in children with diarrhea in Hangzhou[J].Chin JHealth Lab Tec,2017,27(22):3299-3300.
[12]江晓,杜雪飞,叶艳华,等.2015-2016年南京地区儿童感染性腹泻病原学监测结果分析[J].实用预防医学,2018,25(12):1508-1510.DOI:10.3969/j.issn.1006-3110.2018.12.029.Jiang X,Du XF,Ye YH,et al.Analysis pathogenic surveillance results about children's diarrhea in Nanjing area from 2015 to2016[J].Prac Prev Med,2018,25(12):1508-1510.DOI:10 .3969/j.issn.1006-3110.2018.12.029.
[13]张静,常昭瑞,孙军玲,等.我国诺如病毒感染性腹泻流行现状及防制措施建议[J].疾病监测,2014,29(7):516-521.DOI:10.3784/j.issn.1003-9961.2014.07.004.Zhang J,Chang ZR,Sun JL,et al.Infectious diarrhea epidemics caused by norovirus and its control strategy in China[J].Dis Surveill,2014,29(7):516-521.DOI:10.3784/j.issn.1003-9961.2014.07.004.
[14]耿启彬,赖圣杰,余建兴,等.中国26省(直辖市、自治区)2011-2014年5岁以下儿童腹泻病例轮状病毒流行特征分析[J].疾病监测,2016,31(6):463-470.DOI:10.3784/j.issn.1003-9961.2016.06.006.Geng QB,Lai SJ,Yu JX,et al.Epidemiological characteristics of rotavirus caused diarrhea in children aged<5 years in 26provinces in China,2011-2014[J].Dis Surveill,2016,31(6):463-470.DOI:10.3784/j.issn.1003-9961.2016.06.006.
[15]曾玫,朱启镕,钱渊,等.上海地区儿童腹泻病轮状病毒感染的研究[J].中国实用儿科杂志,2004,19(4):217-219.DOI:10.3969/j.issn.1005-2224.2004.04.012.Zeng M,Zhu QR,Qiang Y,et al.Study on rotavirus infection in children with diarrhea in Shanghai[J].Chin J Pract Pediat,2004,19(4):217-219.DOI:10.3969/j.issn.1005-2224.2004.04.012.
[16]潘以韵,黄瑛,朱启镕.上海部分地区小于5岁儿童轮状病毒及星状病毒性腹泻的临床分析[J].微生物与感染,2008,3(3):138-142.DOI:10.3969/j.issn.1673-6184.2008.03.004.Pan YY,Huang Y,Zhu QR.Clinical analysis of diarrhea as a result of rotavirus and astrovirus infection in children below the age of 5years in Shanghai[J].J Microb Infect,2008,3(3):138-142.DOI:10.3969/j.issn.1673-6184.2008.03.004.
[17]赵兰兰,朱朝敏,张爱华.1997-2006年重庆地区儿童细菌性腹泻病原菌分布与药敏结果分析[J].中国实用儿科杂志,2008,23(1):45-49.DOI:10.3969/j.issn.1005-2224.2008.01.015.Zhao LL,Zhu ZM,Zhang AH.Analysis of distribution and drug resistance of pathogenic bacteria about children's diarrhea in Chongqing area from 1997 to 2006[J].Chin J Pract Pediat,2008,23(1):45-49.DOI:10.3969/j.issn.1005-2224.2008.01.015.
[18]Guerrant RL,Kirchhoff LV,Shields DS,et al.Prospective study of diarrheal illnesses in northeastern Brazil:patterns of disease,nutritional impact,etiologies,and risk factors[J].J Infect Dis,1983,148(6):986-997.DOI:10.1093/infdis/148.6.986.
[19]Moreno ACR,Filho AF,Do Amaral Tardelli Gomes T,et al.Etiology of childhood diarrhea in the northeast of Brazil:significant emergent diarrheal pathogens[J].Diagn Microbiol Infect Dis,2010,66(1):50-57.DOI:10.1016/j.diagmicrobio.2008.03.017.
[20]全国细菌耐药检测网.2017年全国细菌耐药监测报告(简要版)[EB/OL].(2018-11-30)[2019-01-11].http://www.carss.cn/Report/Details?aId=552.China Antimicrobial Resistance Surveillance System.2017 China antimicrobial resistance surveillance report[EB/OL].(2018-11-30)[2019-01-11].http://www.carss.cn/Report/Details?aId=552.
[2]WHO.Diarrhoeal disease key facts[EB/OL].(2017-05-02)[2018-12-26].https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease.
[3]林玫,董柏青.感染性腹泻流行病学研究现况[J].中国热带医学,2008,8(4):675-677.DOI:10.3969/j.issn.1009-9727.2008.04.078.Lin M,Dong BQ.Status in epidemiological research of infectious diarrhea[J].China Trop Med,2008,8(4):675-677.DOI:10 .3969/j.issn.1009-9727.2008.04.078.
[4]厉小玉,岳美娜,王云桥,等.2008-2012年杭州市儿童感染性腹泻的志贺菌和沙门菌变迁及耐药性分析[J].疾病监测,2014,29(5):364-368.DOI:10.3784/j.issn.1003-9961.2014.05.008.Li XY,Yue MN,Wang YQ,et al.Salmonella and Shigella caused infectious diarrhea in children and pathogens’drug resistance in Hangzhou,Zhejiang,2008-2012[J].Dis Surveill,2014,29(5):364-368.DOI:10.3784/j.issn.1003-9961.2014.05.008.
[5]顾宝柯,袁政安,金汇明,等.上海市沙门菌病流行特征分析[J].环境与职业医学,2008,25(3):245-247,251.DOI:10.3969/j.issn.1006-3617.2008.03.006.Gu BK,Yuan ZA,Jin HM,et al.Epidemiological surveillance of salmonellosis in Shanghai[J].J Environ Occup Med,2008,25(3):245-247,251.DOI:10.3969/j.issn.1006-3617.2008.03.006.
[6]雷蕾,茌静,余光清,等.2012-2014年深圳市宝安区成人和儿童感染性腹泻病原学分析[J].实用预防医学,2016,23(8):934-937.DOI:10.3969/j.issn.1006-3110.2016.08.012.Lei L,Chi J,Yu GQ,et al.Etiological analysis of infectious diarrhea among adults and children in Baoan district,Shenzhen city,2012-2014[J].Prac Prev Med,2016,23(8):934-937.DOI:10.3969/j.issn.1006-3110.2016.08.012.
[7]费怡,孙乔,傅益飞,等.上海市浦东新区5岁以下儿童腹泻病病原谱监测分析[J].上海预防医学杂志,2013(11):602-605.DOI:10.3969/j.issn.1673-6184.2008.03.004.Fei Y,Sun Q,Fu YF,et al.Surveillance and analysis on diarrheal disease pathogen spectrum among children under 5 years old in Pudong new area of Shanghai city[J].Shanghai J Prev Med,2013(11):602-605.DOI:10.3969/j.issn.1673-6184.2008.03.004.
[8]匡建梅,徐全民,王海革,等.青岛市急性腹泻患儿致泻性大肠埃希菌菌型分布和耐药性分析[J].中国妇幼保健,2016,31(19):3956-3958.DOI:10.7620/zgfybj.j.issn.1001-4411.2016.19.30.Kuang JM,Xu QM,Wang HG,et al.Analysis of distribution and drug resistance of diarrheagenic Escherichia coli about children's acute diarrhea in Qingdao[J].Mat Child Health Care China,2016,31(19):3956-3958.DOI:10.7620/zgfybj.j.issn.1001-4411.2016.19.30.
[9]赵嘉咏,朱敏,谢志强,等.河南省5种致泻性大肠埃希菌病原学监测[J].中国病原生物学杂志,2015,10(10):924-927,935.DOI:10.13350/j.cjpb.151014.Zhao JY,Zhu M,Xie ZQ,et al.Etiologic surveillance and study of five types of diarrheagenic Escherichia coli in Henan province[J].J Path Biol,2015,10(10):924-927,935.DOI:10.13350/j.cjpb.151014.
[10]石挺丽,黄建华,李秀芬,等.2014-2015年广州地区腹泻患儿和健康儿童致泻性大肠埃希菌流行特征及耐药分析[J].中华疾病控制杂志,2016,20(4):329-332.DOI:10.16462/j.cnki.zhjbkz.2016.04.002.Shi TL,Huang JH,Li XF,et al.Epidemiological characterization and antimicrobial resistance of diarrhea Escherichia coli from acute diarrheal and healthy children in Guangzhou city,2014-2015[J].Chin J Dis Control Prev,2016,20(4):329-332.DOI:10.16462/j.cnki.zhjbkz.2016.04.002.
[11]胡雪,厉小玉,周俊,等.杭州市腹泻儿童感染致泻性大肠埃希菌的病原学特征分析[J].中国卫生检验杂志,2017,27(22):3299-3300.Hu X,Li XY,Zhou J,et al.Characterization analysis of diarrhea Escherichia coli in children with diarrhea in Hangzhou[J].Chin JHealth Lab Tec,2017,27(22):3299-3300.
[12]江晓,杜雪飞,叶艳华,等.2015-2016年南京地区儿童感染性腹泻病原学监测结果分析[J].实用预防医学,2018,25(12):1508-1510.DOI:10.3969/j.issn.1006-3110.2018.12.029.Jiang X,Du XF,Ye YH,et al.Analysis pathogenic surveillance results about children's diarrhea in Nanjing area from 2015 to2016[J].Prac Prev Med,2018,25(12):1508-1510.DOI:10 .3969/j.issn.1006-3110.2018.12.029.
[13]张静,常昭瑞,孙军玲,等.我国诺如病毒感染性腹泻流行现状及防制措施建议[J].疾病监测,2014,29(7):516-521.DOI:10.3784/j.issn.1003-9961.2014.07.004.Zhang J,Chang ZR,Sun JL,et al.Infectious diarrhea epidemics caused by norovirus and its control strategy in China[J].Dis Surveill,2014,29(7):516-521.DOI:10.3784/j.issn.1003-9961.2014.07.004.
[14]耿启彬,赖圣杰,余建兴,等.中国26省(直辖市、自治区)2011-2014年5岁以下儿童腹泻病例轮状病毒流行特征分析[J].疾病监测,2016,31(6):463-470.DOI:10.3784/j.issn.1003-9961.2016.06.006.Geng QB,Lai SJ,Yu JX,et al.Epidemiological characteristics of rotavirus caused diarrhea in children aged<5 years in 26provinces in China,2011-2014[J].Dis Surveill,2016,31(6):463-470.DOI:10.3784/j.issn.1003-9961.2016.06.006.
[15]曾玫,朱启镕,钱渊,等.上海地区儿童腹泻病轮状病毒感染的研究[J].中国实用儿科杂志,2004,19(4):217-219.DOI:10.3969/j.issn.1005-2224.2004.04.012.Zeng M,Zhu QR,Qiang Y,et al.Study on rotavirus infection in children with diarrhea in Shanghai[J].Chin J Pract Pediat,2004,19(4):217-219.DOI:10.3969/j.issn.1005-2224.2004.04.012.
[16]潘以韵,黄瑛,朱启镕.上海部分地区小于5岁儿童轮状病毒及星状病毒性腹泻的临床分析[J].微生物与感染,2008,3(3):138-142.DOI:10.3969/j.issn.1673-6184.2008.03.004.Pan YY,Huang Y,Zhu QR.Clinical analysis of diarrhea as a result of rotavirus and astrovirus infection in children below the age of 5years in Shanghai[J].J Microb Infect,2008,3(3):138-142.DOI:10.3969/j.issn.1673-6184.2008.03.004.
[17]赵兰兰,朱朝敏,张爱华.1997-2006年重庆地区儿童细菌性腹泻病原菌分布与药敏结果分析[J].中国实用儿科杂志,2008,23(1):45-49.DOI:10.3969/j.issn.1005-2224.2008.01.015.Zhao LL,Zhu ZM,Zhang AH.Analysis of distribution and drug resistance of pathogenic bacteria about children's diarrhea in Chongqing area from 1997 to 2006[J].Chin J Pract Pediat,2008,23(1):45-49.DOI:10.3969/j.issn.1005-2224.2008.01.015.
[18]Guerrant RL,Kirchhoff LV,Shields DS,et al.Prospective study of diarrheal illnesses in northeastern Brazil:patterns of disease,nutritional impact,etiologies,and risk factors[J].J Infect Dis,1983,148(6):986-997.DOI:10.1093/infdis/148.6.986.
[19]Moreno ACR,Filho AF,Do Amaral Tardelli Gomes T,et al.Etiology of childhood diarrhea in the northeast of Brazil:significant emergent diarrheal pathogens[J].Diagn Microbiol Infect Dis,2010,66(1):50-57.DOI:10.1016/j.diagmicrobio.2008.03.017.
[20]全国细菌耐药检测网.2017年全国细菌耐药监测报告(简要版)[EB/OL].(2018-11-30)[2019-01-11].http://www.carss.cn/Report/Details?aId=552.China Antimicrobial Resistance Surveillance System.2017 China antimicrobial resistance surveillance report[EB/OL].(2018-11-30)[2019-01-11].http://www.carss.cn/Report/Details?aId=552.