一起由金黄色葡萄球菌引起食物中毒的实验室诊断
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摘要
目的对一起食物中毒进行相关样品的实验室检测,针对分离病原菌进行分子分型溯源和耐药分析。方法对可疑食品(冰激凌、牛奶)样品、患者呕吐物和粪便标本使用国家标准或其他方法进行沙门菌、志贺菌、致泻大肠埃希菌、金黄色葡萄球菌、单核细胞增生李斯特菌、蜡样芽胞杆菌和诺如病毒检测。对检出的金黄色葡萄球菌进行肠毒素检测、脉冲场凝胶电泳(PFGE)分型和抗生素敏感性检测。结果从生产冰激凌剩余牛奶及冰激凌样品中检出金黄色葡萄球菌12株,患者呕吐物和粪便标本中检出4株,菌株均产生A+C+E混合型肠毒素,PFGE显示患者呕吐物、粪便、中毒同批冰激凌样品、生产冰激凌用牛奶中检出的金黄色葡萄球菌菌株同源性为100.0%;药敏结果显示,这16株菌株均对青霉素和红霉素耐药。结论本起事件是由冰激凌加工点使用了被金黄色葡萄球菌污染且产生大量肠毒素的牛奶生产冰激凌所致。建议监管部门加强对农村食品小作坊、牛奶供应站等生产经营场所的监管,预防类似事件的发生。
Objective Laboratorial detection were performed on a case of a food poisoning. Meanwhile, pulse field gel electrophoresis(PFGE) and antimicrobial susceptibility testing were carried out for pathogens obtained. Methods Suspected milk and ice cream, vomitus and feces specimens were tested for Salmonella, Shigella, diarrheogenic Escherichia coli, Staphylococcus aureus, Listeria monocytogenes, Bacillus cereus, and Norovirus in accordance with the method of national food safety standard and others. Analysis of enterotoxins, PFGE and antimicrobial susceptibility testing of Staphylococcus aureus isolates were performed. Results Totally, twelve strains of Staphylococcus aureus from milk and ice cream specimens, four strains from the vomitus and the fecal specimens of the patient were cultured. All these strains were found to be able to produce type A, C, and E enterotoxins. Further molecular subtyping by PFGE analysis showed that these strains produced indistinguishable pulsotypes. Moreover, these strains were resistant to penicillin and erythromycin. Conclusion This food poisoning outbreak was associated with the milk contaminated with Staphylococcus aureus stains and produced large amounts of enterotoxin, and the ice cream processing centers used the contaminated milk.It is recommended that the supervision department should strengthen the supervision of the food producers especially in rural areas and milk supply stations in order to prevent the outbreaks of similar incident.
Objective Laboratorial detection were performed on a case of a food poisoning. Meanwhile, pulse field gel electrophoresis(PFGE) and antimicrobial susceptibility testing were carried out for pathogens obtained. Methods Suspected milk and ice cream, vomitus and feces specimens were tested for Salmonella, Shigella, diarrheogenic Escherichia coli, Staphylococcus aureus, Listeria monocytogenes, Bacillus cereus, and Norovirus in accordance with the method of national food safety standard and others. Analysis of enterotoxins, PFGE and antimicrobial susceptibility testing of Staphylococcus aureus isolates were performed. Results Totally, twelve strains of Staphylococcus aureus from milk and ice cream specimens, four strains from the vomitus and the fecal specimens of the patient were cultured. All these strains were found to be able to produce type A, C, and E enterotoxins. Further molecular subtyping by PFGE analysis showed that these strains produced indistinguishable pulsotypes. Moreover, these strains were resistant to penicillin and erythromycin. Conclusion This food poisoning outbreak was associated with the milk contaminated with Staphylococcus aureus stains and produced large amounts of enterotoxin, and the ice cream processing centers used the contaminated milk.It is recommended that the supervision department should strengthen the supervision of the food producers especially in rural areas and milk supply stations in order to prevent the outbreaks of similar incident.
引文
[1] 中华人民共和国卫生部. 食品安全国家标准食品微生物学检验沙门氏菌检验:GB 4789.4—2010[S].北京:中国标准出版社,2010.
[2] 中华人民共和国卫生部. 食品安全国家标准食品微生物学检验志贺氏菌检验:GB 4789.5—2012[S].北京:中国标准出版社,2012.
[3] 中华人民共和国卫生部,中国国家标准化管理委员会.食品卫生微生物学检验致泻大肠埃希氏菌检验:GB/T 4789.6—2003[S].北京:中国标准出版社,2003.
[4] 中华人民共和国卫生部. 食品安全国家标准食品微生物学检验金黄色葡萄球菌检验:GB 4789.10—2010[S].北京:中国标准出版社,2010.
[5] 中华人民共和国国家卫生和计划生育委员会. 食品安全国家标准食品微生物学检验蜡样芽胞杆菌检验:GB 4789.14—2014[S].北京:中国标准出版社,2014.
[6] 中华人民共和国卫生部.食品安全国家标准食品微生物学检验单核细胞增生李斯特氏菌检验:GB 4789.30—2010[S].北京:中国标准出版社,2010.
[7] 中华人民共和国卫生部. 感染性腹泻诊断标准:WS 271—2007[S].北京:人民卫生出版社, 2007.
[8] 中华人民共和国卫生部.细菌性和阿米巴性痢疾诊断标准:WS 287—2008[S].北京:人民卫生出版社, 2008.
[9] 国家食品安全风险评估中心.2016年食源性疾病监测工作手册[Z].2016.
[10] Clinical and Laboratory Standards Institute. M07-A9 methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically [S]. Wayne, PA: Clinical and Laboratory Standards Institute, 2012.
[11] 中华人民共和国卫生部. 葡萄球菌食物中毒诊断标准及处理原则:WS/T 80—1996 [S]. 北京:中国标准出版社,1996.
[12] 梁毅珊.金黄色葡萄球菌肠毒素及其检测方法的研究进展[J]. 中国热带医学,2008,8(9):1658-1659.
[13] 陈艳, 刘秀梅, 樊永祥, 等. 2004年中国食源性疾病暴发事件监测资料分析[J].中国食品卫生杂志, 2008, 20 (6): 503-506.
[14] 刘秀梅, 陈艳, 郭云昌, 等.2005年中国食源性疾病暴发事件监测资料分析[J].中国食品卫生杂志, 2008, 20 (6): 506-509.
[15] 崔莹, 张丁, 张秀丽. 一起由金黄色葡萄球菌及其肠毒素引起的食物中毒实验室分析[J]. 中国卫生检验, 2014, 24 (8): 1162-1164.
[2] 中华人民共和国卫生部. 食品安全国家标准食品微生物学检验志贺氏菌检验:GB 4789.5—2012[S].北京:中国标准出版社,2012.
[3] 中华人民共和国卫生部,中国国家标准化管理委员会.食品卫生微生物学检验致泻大肠埃希氏菌检验:GB/T 4789.6—2003[S].北京:中国标准出版社,2003.
[4] 中华人民共和国卫生部. 食品安全国家标准食品微生物学检验金黄色葡萄球菌检验:GB 4789.10—2010[S].北京:中国标准出版社,2010.
[5] 中华人民共和国国家卫生和计划生育委员会. 食品安全国家标准食品微生物学检验蜡样芽胞杆菌检验:GB 4789.14—2014[S].北京:中国标准出版社,2014.
[6] 中华人民共和国卫生部.食品安全国家标准食品微生物学检验单核细胞增生李斯特氏菌检验:GB 4789.30—2010[S].北京:中国标准出版社,2010.
[7] 中华人民共和国卫生部. 感染性腹泻诊断标准:WS 271—2007[S].北京:人民卫生出版社, 2007.
[8] 中华人民共和国卫生部.细菌性和阿米巴性痢疾诊断标准:WS 287—2008[S].北京:人民卫生出版社, 2008.
[9] 国家食品安全风险评估中心.2016年食源性疾病监测工作手册[Z].2016.
[10] Clinical and Laboratory Standards Institute. M07-A9 methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically [S]. Wayne, PA: Clinical and Laboratory Standards Institute, 2012.
[11] 中华人民共和国卫生部. 葡萄球菌食物中毒诊断标准及处理原则:WS/T 80—1996 [S]. 北京:中国标准出版社,1996.
[12] 梁毅珊.金黄色葡萄球菌肠毒素及其检测方法的研究进展[J]. 中国热带医学,2008,8(9):1658-1659.
[13] 陈艳, 刘秀梅, 樊永祥, 等. 2004年中国食源性疾病暴发事件监测资料分析[J].中国食品卫生杂志, 2008, 20 (6): 503-506.
[14] 刘秀梅, 陈艳, 郭云昌, 等.2005年中国食源性疾病暴发事件监测资料分析[J].中国食品卫生杂志, 2008, 20 (6): 506-509.
[15] 崔莹, 张丁, 张秀丽. 一起由金黄色葡萄球菌及其肠毒素引起的食物中毒实验室分析[J]. 中国卫生检验, 2014, 24 (8): 1162-1164.