成都市某医院腹泻儿童非伤寒沙门菌感染状况及耐药分析
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摘要
目的分析成都市腹泻儿童非伤寒沙门菌感染的流行病学特征及耐药性,为食品安全控制及临床合理使用抗菌药物提供依据。方法对腹泻儿童340株肠道非伤寒沙门菌进行血清分型及药敏试验。结果非沙门菌感染易感人群为3岁以内儿童占93.24%(317/340),在各年龄组中0～6月患儿非伤寒沙门菌检出率最低占1.78%(47/2 643),差异有统计学意义(P<0.05);1-12月份皆有检出,7-9月是检出高峰占61.18%(208/340);在15种血清型中最常见的血清型为鼠伤寒沙门菌占81.47%(277/340);肠道非伤寒沙门菌对氨苄西林、复方磺胺甲噁唑、环丙沙星和头孢噻肟4种抗菌药物耐药率分别为83.82%(285/340)、40.58%(138/340)、12.06%(41/340)、12.06%(41/340);2017年鼠伤寒沙门菌多重耐药(MDR)率最高95%(38/40)。结论成都市腹泻儿童非伤寒沙门菌感染以3岁以内为高发,鼠伤寒沙门菌是最主要的感染因子,肠道非伤寒沙门菌对环丙沙星和头孢噻肟的敏感性较高,经验性用药首选三代头孢,MDR菌株随时间有增多趋势,应该采取措施控制非伤寒沙门菌耐药性的快速增长。
Objective To analyze the epidemiological characteristics and drug resistance of non-typhoid salmonella infection in children with diarrhea in chengdu and to provide evidence for food safety control and rational use of antibacterials in clinic.Methods The serotyping and antimicrobial resistance tests were performed on 340 strains of enteral non-typhoid salmonella in children with diarrhea.Results The lowest detection rate of non-typhoid salmonella was 1.78%in all age groups from 0 to 6 months(47/2 643),with a statistically significant difference(P<0.05).There were cases detected all over the year,and 61.18% of the samples were detected in July to September,which was the peak(208/340).In 15 serotypings,the most common serotype was S.typhimurium,accounting for 81.47%(277/340).The resistance rates of four antibacterials were 83.82%(285/340),40.58%(138/340),12.06%(41/340),and 12.06%(41/340)respectively for ampicillin,compound sulfamethoxazole,ciprofloxacin and cefotaxime.The multi-drug resistance rate of S.typhimurium was the highest in 2017 accounting for 95%(38/40).Conclusion The high incidence of non-typhoid salmonellain children with diarrhea in Chengdu was under 3 years old.S.typhimurium was the main infectious agent,intestinal non-typhoid salmonella was highly sensitive to ciprofloxacin and cefotaxime,the third-generation cephalosporins was the first choice for empirical medicine.Multi-drug resistance strains increased with the passage of the time.Measures should be taken to control the rapid growth of non-typhoid salmonella resistance to antibacterials.
Objective To analyze the epidemiological characteristics and drug resistance of non-typhoid salmonella infection in children with diarrhea in chengdu and to provide evidence for food safety control and rational use of antibacterials in clinic.Methods The serotyping and antimicrobial resistance tests were performed on 340 strains of enteral non-typhoid salmonella in children with diarrhea.Results The lowest detection rate of non-typhoid salmonella was 1.78%in all age groups from 0 to 6 months(47/2 643),with a statistically significant difference(P<0.05).There were cases detected all over the year,and 61.18% of the samples were detected in July to September,which was the peak(208/340).In 15 serotypings,the most common serotype was S.typhimurium,accounting for 81.47%(277/340).The resistance rates of four antibacterials were 83.82%(285/340),40.58%(138/340),12.06%(41/340),and 12.06%(41/340)respectively for ampicillin,compound sulfamethoxazole,ciprofloxacin and cefotaxime.The multi-drug resistance rate of S.typhimurium was the highest in 2017 accounting for 95%(38/40).Conclusion The high incidence of non-typhoid salmonellain children with diarrhea in Chengdu was under 3 years old.S.typhimurium was the main infectious agent,intestinal non-typhoid salmonella was highly sensitive to ciprofloxacin and cefotaxime,the third-generation cephalosporins was the first choice for empirical medicine.Multi-drug resistance strains increased with the passage of the time.Measures should be taken to control the rapid growth of non-typhoid salmonella resistance to antibacterials.
引文
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[14]HU Y J,HE Y Y,WANG Y R,et al.Serovar diversity and antimicrobial resistance of non-typhoidal Salmonella enterica recovered from retail chicken carcasses for sale in different regions of China[J].Food Control,2017,81(6):46-54.
[15]BALASUBRAMANIAN R,IM J,LEE J S,et al.The global burden and epidemiology of invasive non-typhoidal Salmonella infections[J].Hum Vaccin Immunother,2018,6(3):1-6.
[16]ANDOH L A,AHMED S,OLSEN J E.Prevalence and characterization of Salmonella among humans in Ghana[J].Trop Med Health,2017,45(1):3.
[2]BULA-RUDAS F J,RATHORE M H,MARAQA N F.Salmonella infections in childhood[J].Adv Pediatr,2015,62(1):29-58.
[3]UCHE I V,MACLENNAN C A,SAUL A.A systematic review of the incidence,risk factors and case fatality rates of InvasiveNontyphoidal salmonella(iNTS)disease in Africa(1966to 2014)[J].PLoS Negl Trop Dis,2017,11(1):0005118.
[4]江载芳,申昆玲,沈颖,等.非伤寒沙门菌感染[M].北京:人民卫生出版社,2015:1030-1033.
[5]WEN S C,BEST E,NOURSE C.Non-typhoidal Salmonella infections in children:Review of literature and recommendations for management[J].J Paediatr Child Health,2017,53(10):936-941.
[6]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.
[7]LI Y F,XIE X B,XU X B,et al.Nontyphoidal salmonella infection in children with acute gastroenteritis:prevalence,serotypes,and antimicrobial resistance in Shanghai,China[J].Foodborne Pathog Dis,2014,11(3):200-206.
[8]ZHANG K,DUPONT A,TOROW N,et al.Age-dependent enterocyte invasion and microcolony formation by Salmonella[J].PLoS Pathog,2014,10(9):e1004385.
[9]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.
[10]HENDRIKSEN R S,VIEIRA A R,KARLSMOSE S,et al.Global monitoring of Salmonella serovar distribution from the World Health Organization Global Foodborne Infections Network Country Data Bank:results of quality assured laboratories from 2001to 2007[J].Foodborne Pathog Dis,2011,8(8):887-900.
[11]BHUNIA A K.Salmonella enteric[M].New York:Springer,2018:271-287.
[12]WU C,YAN M,LIU L,et al.Comparative characterization of nontyphoidal Salmonella isolated from humans and food animals in China,2003-2011[J].Heliyon,2018,4(4):e00613.
[13]CHAO G X,WANG C,WU T Q,et al.Molecular epidemiology and antibiotic resistance phenotypes and genotypes of salmonellae from food supply chains in China[J].Food Control,2017,77(12):32-40.
[14]HU Y J,HE Y Y,WANG Y R,et al.Serovar diversity and antimicrobial resistance of non-typhoidal Salmonella enterica recovered from retail chicken carcasses for sale in different regions of China[J].Food Control,2017,81(6):46-54.
[15]BALASUBRAMANIAN R,IM J,LEE J S,et al.The global burden and epidemiology of invasive non-typhoidal Salmonella infections[J].Hum Vaccin Immunother,2018,6(3):1-6.
[16]ANDOH L A,AHMED S,OLSEN J E.Prevalence and characterization of Salmonella among humans in Ghana[J].Trop Med Health,2017,45(1):3.