小儿沙门菌感染临床特点及耐药性分析
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摘要
目的探讨儿童沙门菌感染的临床特点和耐药情况,为临床诊疗提供帮助。方法收集2013～2017年经粪便培养出沙门菌阳性的163例住院患儿的临床特征、沙门菌血清型分布情况及药敏试验结果,并进行回顾性分析。结果 163例沙门菌阳性患儿中,≤1岁患儿79例(48.5%);临床表现以发热、腹泻为主,体温>39℃达121例(74.2%),腹泻超过10次/d有52例(31.9%),且合并呼吸道感染多见,共56例(34.4%);沙门菌感染好发于夏秋季,5～10月共检出131例(80.4%)。血清分型以鼠伤寒沙门菌、肠炎沙门菌为主,分别为100例(61.3%)、15例(9.2%);不同血清型沙门菌对头孢噻肟耐药率均在20%以上,对β内酰胺酶抑制剂(阿莫西林/克拉维酸、哌拉西林/他唑巴坦)敏感性较高,尚未出现对碳青霉烯类(亚胺培南)耐药株。结论≤1岁婴儿夏秋季易感染沙门菌,常见血清型为鼠伤寒沙门菌;临床表现以发热、腹泻为主,合并呼吸道感染多见;沙门菌对三代头孢菌素类的耐药率有所增加,临床治疗应根据药敏试验结果合理使用抗菌药物。
Objective To study the clinical features and drug resistance in children with Salmonella infection. Methods A total of 163 children with positive fecal cultures for Salmonella who were hospitalized between 2013 and 2017 were enrolled. A retrospective analysis was performed for their data on clinical features, distribution of Salmonella serotypes, and drug sensitivity test results. Results Among the 163 children with Salmonella infection, 79(48.5%) were aged ≤1 year. Main clinical manifestations included fever and diarrhea. Of all the children, 121(74.2%) reached a body temperature of above 39°C, 52(31.9%) had diarrhea more than 10 times a day, and 56(34.4%) had respiratory infection. Salmonella infection often occurred in summer and autumn. Of all the children, 131(80.4%) had the infection in May to October. Salmonella typhimurium was observed in 100 children(61.3%) and Salmonella enteritidis was observed 15 children(9.2%). All serotypes of Salmonella had a drug resistance rate of >20% to cefotaxime, as well as high sensitivities to β-lactamase inhibitors(amoxicillin/clavulanic acid and piperacillin/tazobactam). There were no strains resistant to carbapenems including imipenem. Conclusions Infants aged ≤1 year are susceptible to Salmonella infection in summer and autumn, and the most common serotype is Salmonella typhimurium. Main clinical manifestations are fever and diarrhea in children with Salmonella infection, and most children also have respiratory infection. Salmonella has an increased rate of drug resistance to third-generation cephalosporins. In clinical treatment, antimicrobial drugs should be used according to the results of drug sensitivity test.
Objective To study the clinical features and drug resistance in children with Salmonella infection. Methods A total of 163 children with positive fecal cultures for Salmonella who were hospitalized between 2013 and 2017 were enrolled. A retrospective analysis was performed for their data on clinical features, distribution of Salmonella serotypes, and drug sensitivity test results. Results Among the 163 children with Salmonella infection, 79(48.5%) were aged ≤1 year. Main clinical manifestations included fever and diarrhea. Of all the children, 121(74.2%) reached a body temperature of above 39°C, 52(31.9%) had diarrhea more than 10 times a day, and 56(34.4%) had respiratory infection. Salmonella infection often occurred in summer and autumn. Of all the children, 131(80.4%) had the infection in May to October. Salmonella typhimurium was observed in 100 children(61.3%) and Salmonella enteritidis was observed 15 children(9.2%). All serotypes of Salmonella had a drug resistance rate of >20% to cefotaxime, as well as high sensitivities to β-lactamase inhibitors(amoxicillin/clavulanic acid and piperacillin/tazobactam). There were no strains resistant to carbapenems including imipenem. Conclusions Infants aged ≤1 year are susceptible to Salmonella infection in summer and autumn, and the most common serotype is Salmonella typhimurium. Main clinical manifestations are fever and diarrhea in children with Salmonella infection, and most children also have respiratory infection. Salmonella has an increased rate of drug resistance to third-generation cephalosporins. In clinical treatment, antimicrobial drugs should be used according to the results of drug sensitivity test.
引文
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[11]王庭庭,徐飞,李玫,等.儿童沙门菌感染临床特点及耐药模式[J].临床儿科杂志, 2016, 34(4):246-248.
[12]冯幕仁,李波.小儿沙门菌感染649例临床流行病学分析[J].中国当代儿科杂志, 2002, 4(6):519-522.
[13]刘谢,柯碧霞,何冬梅,等. 2007-2013年广东省肠炎沙门菌耐药情况分析[J].中华疾病控制杂志, 2015, 19(3):269-272.
[14]兰海丽,冯雪琴,严海忠,等.综合医院非伤寒沙门菌感染腹泻患者病原学分析[J].中华医院感染学杂志, 2014, 24(8):1874-1876.
[2]叶应妩,王毓三,申子瑜.全国临床检验操作规程[M].第3版.南京:东南大学出版社, 2006:746-749.
[3]WS271-2007,感染性腹泻诊断标准[S].
[4]M100S, Performance standards for antimicrobial susceptibility testing[S].
[5]HendriksenRS, Vieira AR,KarlsmoseS,etal.Global monitoring of salmonella serovar distribution from the World Health Organization Global Foodborne Infections Network Country Data Bank:results of quality assured laboratories from2001 to 2007[J]. Foodborne Pathog Dis, 2011, 8(8):887-900.
[6]王红梅,王和平,雷旻,等.深圳市儿童医院儿童粪便分离的459株沙门菌分布特征及耐药性[J].中国感染控制杂志,2016, 15(11):817-820.
[7]李桦,汪伟山,周玉球. 2009~2014年珠海市腹泻儿童沙门菌感染的流行病学特征[J].国际检验医学杂志, 2015, 36(18):2640-2642.
[8]修宁宁,盘俊均,邓沛汶,等.东莞地区2岁以下婴幼儿沙门菌感染血清型分布特征研究[J].国际检验医学杂志, 2017,38(11):1502-1504.
[9]彭惠诗,余一海,卢敏. 1022例腹泻患儿沙门菌感染调查[J].现代预防医学, 2014, 41(6):1007-1009.
[10]曲梅,黄瑛,吕冰,等.北京市肠道门诊腹泻儿童沙门菌感染状况和耐药性分析[J].现代预防医学, 2017, 44(22):4091-4095.
[11]王庭庭,徐飞,李玫,等.儿童沙门菌感染临床特点及耐药模式[J].临床儿科杂志, 2016, 34(4):246-248.
[12]冯幕仁,李波.小儿沙门菌感染649例临床流行病学分析[J].中国当代儿科杂志, 2002, 4(6):519-522.
[13]刘谢,柯碧霞,何冬梅,等. 2007-2013年广东省肠炎沙门菌耐药情况分析[J].中华疾病控制杂志, 2015, 19(3):269-272.
[14]兰海丽,冯雪琴,严海忠,等.综合医院非伤寒沙门菌感染腹泻患者病原学分析[J].中华医院感染学杂志, 2014, 24(8):1874-1876.