2015—2017年中山市某医院沙门菌的药敏分析及肠毒素基因检测
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摘要
目的研究中山市西北部区域沙门菌感染患者的流行病学特征、耐药特点及其相关肠毒素基因型。方法 2015年1月—2017年12月,我院从4019例腹泻患者的粪便标本中共分离出沙门菌108株,进行血清分型及药物敏感试验,同时采用PCR方法检测其肠毒素基因(spvA、spvB、rck)。结果 108株沙门菌可分为17个血清型,以鼠伤寒沙门菌和斯坦利沙门菌为主,分别占42.6%(46/108)和15.7%(17/108),2015年分别检出伤寒沙门菌、乙型副伤寒沙门菌和丙型副伤寒沙门菌各一株;108株沙门菌对氨苄西林(61.11%)和氨苄西林/舒巴坦(49.07%)耐药率最高,未发现对亚胺培南及哌拉西林/三唑巴坦的耐药菌株;在108株沙门菌中,所有菌株均含有spvA基因,34株为spvB阳性,28株为rck阳性,spvB基因阳性患者其高热、便血的比率显著高于spvB阴性患者(χ~2=4.185, P<0.05;χ~2=6.13, P<0.05);rck基因阳性患者其高热、便血的比率显著高于rck阴性患者(χ~2=5.274, P<0.05,χ~2=8.887,P<0.05)。结论本地区沙门菌感染患者以鼠伤寒沙门菌和斯坦利沙门菌为主,高发季节集中在夏秋两季,沙门菌株耐药率较高。沙门菌感染患者高热及便血的发生率与spvB基因、rck基因的检出具有明显相关性。
Objective To investigate the epidemiological characteristics, drug resistance characteristics, and enterotoxin genotypes of patients infected with Salmonella in the northwestern part of Zhongshan city. Methods From January 2015 to December 2017, 108 strains of Salmonella were isolated from fecal specimens for 4,019 diarrhea patients. The Salmonella serotyping and antimicrobial susceptibility testing were conducted. At the same time, the enterotoxin genes(spvA, spvB, and rck) were detected using PCR. Results The 108 strains of Salmonella were divided into 17 serotypes, of which Salmonella typhimurium and Salmonella stanley were dominant, accounting for 42.6%(46/108) and 15.7%(17/108) respectively. A strain of Salmonella typhi, Salmonella paratyphi B and Salmonella paratyphi C were detected in 2015. The 108 strains of Salmonella had the highest resistance rates to ampicillin(61.11%) and ampicillin/sulbactam(49.07%), and no resistant strains to imipenem and piperacillin/tazobactam were found. Among the 108 strains of Salmonella, all strains contained the spvA gene, 34 strains were positive for spvB, and 28 strains were rck positive. The spvB gene positive patients had significantly higher rates of fever and hematochezia than spvB negative patients(χ~2=4.185, P<0.05, χ~2=6.13, P<0.05). The rck gene positive patients had significantly higher rates of fever and hematochezia than patients with rck negative(χ~2=5.274, P<0.05, χ~2=8.887, P<0.05). ConclusionSalmonella typhimurium and Salmonella stanley are the main serotypes in this area, and such infections usually peak in summer and autumn seasons. Salmonella strains have high resistance rates. The incidence of fever and hematochezia of patients with Salmonella infections was significantly correlated with the detection of the spv B gene and the rck gene.
Objective To investigate the epidemiological characteristics, drug resistance characteristics, and enterotoxin genotypes of patients infected with Salmonella in the northwestern part of Zhongshan city. Methods From January 2015 to December 2017, 108 strains of Salmonella were isolated from fecal specimens for 4,019 diarrhea patients. The Salmonella serotyping and antimicrobial susceptibility testing were conducted. At the same time, the enterotoxin genes(spvA, spvB, and rck) were detected using PCR. Results The 108 strains of Salmonella were divided into 17 serotypes, of which Salmonella typhimurium and Salmonella stanley were dominant, accounting for 42.6%(46/108) and 15.7%(17/108) respectively. A strain of Salmonella typhi, Salmonella paratyphi B and Salmonella paratyphi C were detected in 2015. The 108 strains of Salmonella had the highest resistance rates to ampicillin(61.11%) and ampicillin/sulbactam(49.07%), and no resistant strains to imipenem and piperacillin/tazobactam were found. Among the 108 strains of Salmonella, all strains contained the spvA gene, 34 strains were positive for spvB, and 28 strains were rck positive. The spvB gene positive patients had significantly higher rates of fever and hematochezia than spvB negative patients(χ~2=4.185, P<0.05, χ~2=6.13, P<0.05). The rck gene positive patients had significantly higher rates of fever and hematochezia than patients with rck negative(χ~2=5.274, P<0.05, χ~2=8.887, P<0.05). ConclusionSalmonella typhimurium and Salmonella stanley are the main serotypes in this area, and such infections usually peak in summer and autumn seasons. Salmonella strains have high resistance rates. The incidence of fever and hematochezia of patients with Salmonella infections was significantly correlated with the detection of the spv B gene and the rck gene.
引文
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[4]黄宝兴,马东礼.深圳市某儿童医院沙门菌属菌群分布及耐药性分析[J].实用预防医学,2015,22(7):880-881,872.
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[12]黄邀,陈玲玲,陆卫民.浙江省台州市儿童腹泻132例沙门菌耐药性检测及肠毒素基因的相关分析[J].中国基层医药,2018,25(3):356-359.
[13]孙佰秀,阮田田,田园园.儿童腹泻沙门菌和志贺菌的分布及耐药性分析[J].中国小儿急救医学,2016,23(9):639-640,644.
[14]张晶,张欣强,侯水平,等.广州市566株腹泻病例沙门菌的血清型分布及耐药性分析[J].实用预防医学,2016,23(5):616-617,623.
[15]白莉,张秀丽,甘辛,等.肉鸡养殖场中环丙沙星和头孢噻肟双重耐药沙门菌耐药机制的研究[J].中国食品卫生杂志,2015,27(5):487-494.
[16]郑悦康,区金结.2015年珠三角某市沙门菌监测及其病原学特征分析[J].中国当代医药,2017,24(22):148-150,162.
[17]Roberts C G,Chan-Myers H B,Favero M S.Virucidal activity of ortho-phthalaldehyde solutions against hepatitis B and Cviruses[J].Amer J Infect Control,2008,36(3):223-226.
[18]刘晓艳,陈强,李红,等.spvB/spvC基因对沙门菌毒力及宿主免疫功能的影响[J].南方医科大学学报,2015,35(11):1649-1654.
[19]朱春晖,王文杏,陈强,等.鼠伤寒沙门菌质粒毒力基因对耐药表型的影响[J].郑州大学学报(医学版),2018,53(2):192-198.
[2]Schroeder S,Harries M,Prager R,et al.A prolonged outbreak of Salmonella infantis associated with pork products in central Germany,April-October 2013[J].Epidemiol Infect,2015,144(7):1429-1439.
[3]杨晓华,谭南,林爱心.小儿沙门菌肠炎344例病原菌分布及药敏试验结果[J].中国感染与化疗杂志,2014,14(2):149-152.
[4]黄宝兴,马东礼.深圳市某儿童医院沙门菌属菌群分布及耐药性分析[J].实用预防医学,2015,22(7):880-881,872.
[5]何冬梅,柯碧霞,邓小玲,等.2010年广东省沙门菌监测及其病原学特征分析[J].中华预防医学杂志,2012,46(5):424-429.
[6]Liu L,Oza S,Hogan D,et al.Global,regional,and national causes of child mortality in 2000-2013,with projections to inform post-2015 priorities:an updated systematic analysis[J].Lancet,2015,385(9966):430-440.
[7]张琳,梁庆红,王烨,等.肠道微生态与儿童期胃肠疾病[J].中华实用儿科临床杂志,2014,29(7):487-492.
[8]热病-桑福德抗微生物治疗指南(新译第44版)[M].中国协和医科大学出版社,2014:60.
[9]Griggs D J,Gensberg K,Piddock L J.Mutations in gryAof quinolone-resistant Salmonella serotypes isolated from humans and animals[J].Antimicrob Agents Chemother,1996,40(4):1009-1013.
[10]Clinical and Laboratory Standards Institute.Performance standards for antimicrobial susceptibility testing:23rd informational supplement[S].CLSI document M100-S32,Wayne,PA:CLSI,2013.
[11]许云敏,杜艳,单斌,等.2005-2014年CHINET沙门菌属细菌耐药性监测[J].中国感染与化疗杂志,2016,16(3):294-301.
[12]黄邀,陈玲玲,陆卫民.浙江省台州市儿童腹泻132例沙门菌耐药性检测及肠毒素基因的相关分析[J].中国基层医药,2018,25(3):356-359.
[13]孙佰秀,阮田田,田园园.儿童腹泻沙门菌和志贺菌的分布及耐药性分析[J].中国小儿急救医学,2016,23(9):639-640,644.
[14]张晶,张欣强,侯水平,等.广州市566株腹泻病例沙门菌的血清型分布及耐药性分析[J].实用预防医学,2016,23(5):616-617,623.
[15]白莉,张秀丽,甘辛,等.肉鸡养殖场中环丙沙星和头孢噻肟双重耐药沙门菌耐药机制的研究[J].中国食品卫生杂志,2015,27(5):487-494.
[16]郑悦康,区金结.2015年珠三角某市沙门菌监测及其病原学特征分析[J].中国当代医药,2017,24(22):148-150,162.
[17]Roberts C G,Chan-Myers H B,Favero M S.Virucidal activity of ortho-phthalaldehyde solutions against hepatitis B and Cviruses[J].Amer J Infect Control,2008,36(3):223-226.
[18]刘晓艳,陈强,李红,等.spvB/spvC基因对沙门菌毒力及宿主免疫功能的影响[J].南方医科大学学报,2015,35(11):1649-1654.
[19]朱春晖,王文杏,陈强,等.鼠伤寒沙门菌质粒毒力基因对耐药表型的影响[J].郑州大学学报(医学版),2018,53(2):192-198.