儿童侵袭性沙门菌感染的临床特点和药物敏感性分析
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摘要
目的探讨儿童侵袭性沙门菌感染的病原血清型分布及耐药特征。方法回顾分析2012年1月至2015年12月经血液或脓液培养确诊的66例侵袭性沙门菌感染患儿的临床特点、血清型分布和药敏结果。结果 66例患儿中,男48例、女18例,2岁以下43例;住院患儿60例,门诊患儿6例;5—10月份检出者占80.30%。住院患儿主要临床表现为发热55例(91. 67%)、腹痛和/或腹泻32例(53. 33%)、贫血36例(60. 00%)、咳嗽28例(46. 67%)、肝脏肿大24例(40. 00%)、脾脏肿大12例(20.00%)。所有患儿中,白细胞总数升高45例(68.18%),嗜酸性粒细胞比例下降56例(84.85%),其中15例嗜酸性粒细胞消失,超敏C反应蛋白不同程度升高51例(77. 27%)。沙门菌血清型主要分布在D群和B群,分别为26例(39.39%)和22例(33.33%);未检出耐亚胺培南和厄他培南侵袭性沙门菌菌株,检出菌株对头孢吡肟、头孢他啶、头孢曲松和氨曲南的敏感率均>70.00%。结论儿童侵袭性沙门菌感染在<2岁婴幼儿中最为多见,5—10月份高发,血清型以D群和B群为主,临床表现多样,应结合血清型及药敏结果慎重选择抗生素治疗。
Objective To explore the pathogen serotype distribution and drug resistance characteristics of invasive Salmonella infection in children. Method The clinical characteristics, serotype distribution and drug sensitivity of 66 children with invasive Salmonella infection confirmed by blood or pus culture from January 2012 to December 2015 were retrospectively analyzed. Results Among 66 children(48 males and 18 females) included, there were 60 hospitalized and 6 outpatient children, and 43 were under 2 years old. Strains were mainly found from May to October(80.30%, 53/66). The main clinical manifestations of hospitalized children were fever(55 cases, 91.67%), abdominal pain and/or diarrhea(32 cases, 53.33%), anemia(36 cases, 60.00%), cough(28 cases, 46.67%), hepatomegaly(24 cases, 40.00%) and splenomegaly(12 cases, 20.00%). Among all the children, 45(68.18%) had increased white blood cell counts, 56(84.85%) had decreased proportion of eosinophils(eosinophils disappeared in 15 cases), and 51(77.27%) had increased level of hypersensitive C-reactive protein. Salmonella serotypes were mainly group D and group B, accounting for 39.39%(26 cases) and 33.33%(22 cases) respectively. The invasive Salmonella strains resistant to imipenem and ertapenem were not detected, and the sensitivities of the detected strains to cefepime, ceftazidime, ceftriaxone and aztreonam were all >70.00%. Conclusion Invasive Salmonella infection is most common in children under 2 years of age, with prevalence from May to October. Salmonella serotypes were mainly group D and group B, and the clinical manifestations are diverse. Antibiotic treatment should be carefully selected in combination with serotype and drug susceptibility results.
Objective To explore the pathogen serotype distribution and drug resistance characteristics of invasive Salmonella infection in children. Method The clinical characteristics, serotype distribution and drug sensitivity of 66 children with invasive Salmonella infection confirmed by blood or pus culture from January 2012 to December 2015 were retrospectively analyzed. Results Among 66 children(48 males and 18 females) included, there were 60 hospitalized and 6 outpatient children, and 43 were under 2 years old. Strains were mainly found from May to October(80.30%, 53/66). The main clinical manifestations of hospitalized children were fever(55 cases, 91.67%), abdominal pain and/or diarrhea(32 cases, 53.33%), anemia(36 cases, 60.00%), cough(28 cases, 46.67%), hepatomegaly(24 cases, 40.00%) and splenomegaly(12 cases, 20.00%). Among all the children, 45(68.18%) had increased white blood cell counts, 56(84.85%) had decreased proportion of eosinophils(eosinophils disappeared in 15 cases), and 51(77.27%) had increased level of hypersensitive C-reactive protein. Salmonella serotypes were mainly group D and group B, accounting for 39.39%(26 cases) and 33.33%(22 cases) respectively. The invasive Salmonella strains resistant to imipenem and ertapenem were not detected, and the sensitivities of the detected strains to cefepime, ceftazidime, ceftriaxone and aztreonam were all >70.00%. Conclusion Invasive Salmonella infection is most common in children under 2 years of age, with prevalence from May to October. Salmonella serotypes were mainly group D and group B, and the clinical manifestations are diverse. Antibiotic treatment should be carefully selected in combination with serotype and drug susceptibility results.
引文
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[11]Tapia MD,Tennant SM,Bornstein K,et al.Invasive nontyphoidal Salmonella infections among children in Mali,2002-2014:microbiological and epidemiologic features guide vaccine development[J].Clin Infect Dis,2015,61(Suppl 4):S332-S338.
[12]Passos J.Aneosinophilia in typhoid fever[J].An Inst Med Trop(Lisb),1953,10(31):999-1001.
[13]Farmakiotis D,Ntouloulis C,Mihailidis N,et al.Diagnostic value of eosinopenia in non-Typhi Salmonella enteritis[J].Clin Infect Dis,2014,59(8):1197-1198.
[14]Mac Lennan CA,Msefula CL,Gondwe EN,et al.Presentation of life-threatening invasive nontyphoidal Salmonella disease in Malawian children:a prospective observational study[J].PLo S Negl Trop Dis,2017,11(12):e0006027.
[15]储从家,孔繁林,吴惠玲,等.需氧厌氧培养方式对甲型副伤寒沙门菌检出率的影响[J].中国微生态学杂志,2007,19(6):573-574.
[16]李光辉,朱德妹,汪复,等.2012年中国CHINET血培养临床分离菌的分布及耐药性[J].中国感染与化疗杂志,2014,14(6):474-481.
[2]Frye JG,Fedorka-Cray PJ.Prevalence,distribution and characterisation of ceftiofur resistance in Salmonella enterica isolated from animals in the USA from 1999 to 2003[J].Int JAntimicrob Agents,2007,30(2):134-142.
[3]Hendriksen RS,Mikoleit M,Carlson VP,et al.WHO Global Salm-Surv external quality assurance system for serotyping of Salmonella isolates from 2000 to 2007[J].J Clin Microbiol,2009,47(9):2729-2736.
[4]Hendriksen RS,Seyfarth AM,Jensen AB,et al.Results of use of WHO Global Salm-Surv external quality assurance system for antimicrobial susceptibility testing of Salmonella isolates from 2000 to 2007[J].J Clin Microbiol,2009,47(1):79-85.
[5]Krumkamp R,Kreuels B,Sarpong N,et al.Association between malaria and invasive nontyphoidal Salmonella infection in a hospital study:accounting for berkson's bias[J].Clin Infect Dis,2016,62(Suppl 1):S83-S89.
[6]Feasey NA,Dougan G,Kingsley RA,et al.Invasive nontyphoidal salmonella disease:an emerging and neglected tropical disease in Africa[J].Lancet,2012,379(9835):2489-2499.
[7]王树坤,储从家,山德生,等.甲型副伤寒病例血培养研究[J].中华检验医学杂志,2009,32(5):543-546.
[8]Feasey NA,Hadfield J,Keddy KH,et al.Erratum:distinct Salmonella Enteritidis lineages associated with enterocolitis in high-income settings and invasive disease in low-income settings[J].Nat Genet,2017,49(4):651.
[9]Marks F,von Kalckreuth V,Aaby P,et al.Incidence of invasive salmonella disease in sub-Saharan Africa:a multicentre population-based surveillance study[J].Lancet Glob Health,2017,5(3):e310-e323.
[10]Crump JA,Sj?lund-Karlsson M,Gordon MA,et al.Epidemiology,clinical presentation,laboratory diagnosis,antimicrobial resistance,and antimicrobial management of invasive Salmonella infections[J].Clin Microbiol Rev,2015,28(4):901-937.
[11]Tapia MD,Tennant SM,Bornstein K,et al.Invasive nontyphoidal Salmonella infections among children in Mali,2002-2014:microbiological and epidemiologic features guide vaccine development[J].Clin Infect Dis,2015,61(Suppl 4):S332-S338.
[12]Passos J.Aneosinophilia in typhoid fever[J].An Inst Med Trop(Lisb),1953,10(31):999-1001.
[13]Farmakiotis D,Ntouloulis C,Mihailidis N,et al.Diagnostic value of eosinopenia in non-Typhi Salmonella enteritis[J].Clin Infect Dis,2014,59(8):1197-1198.
[14]Mac Lennan CA,Msefula CL,Gondwe EN,et al.Presentation of life-threatening invasive nontyphoidal Salmonella disease in Malawian children:a prospective observational study[J].PLo S Negl Trop Dis,2017,11(12):e0006027.
[15]储从家,孔繁林,吴惠玲,等.需氧厌氧培养方式对甲型副伤寒沙门菌检出率的影响[J].中国微生态学杂志,2007,19(6):573-574.
[16]李光辉,朱德妹,汪复,等.2012年中国CHINET血培养临床分离菌的分布及耐药性[J].中国感染与化疗杂志,2014,14(6):474-481.