儿童非伤寒沙门菌肠道感染的流行病学特点和药敏结果分析
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摘要
目的:了解本地区儿童非伤寒沙门菌肠道感染的流行病学特点,并监测其对抗菌药物的敏感性,探讨阿奇霉素治疗肠道非伤寒沙门菌感染的可能性,为进一步控制非伤寒沙门菌感染提供参考。方法:回顾性分析2014年7月至2016年6月深圳市儿童医院确诊并住院治疗的76例肠道非伤寒沙门菌感染患儿的年龄、性别、发病季节等流行病学特点;采用纸片扩散法检测5种常用抗菌药物的敏感性,采用E-Test法和纸片扩散法检测阿奇霉素的最低抑菌浓度(MIC),并对阿奇霉素的MIC值与其抑菌圈直径进行直线相关回归分析。结果:76株非伤寒沙门菌属于4种血清型,以鼠伤寒沙门菌血清型和肠炎沙门菌血清型为主; 1岁以下小婴儿54例,占71. 05%;非伤寒沙门菌对复方磺胺甲唑、头孢曲松、氯霉素、奈定酸、氨苄西林的敏感性分别为73. 68%、63. 16%、60. 53%、27. 63%和22. 37%;检出多重耐药非伤寒沙门菌16株,占21. 05%; E-Test法检测阿奇霉素对沙门菌的MIC为2～96μg/m L,MIC50为3μg/m L,MIC90为4μg/m L;纸片扩散法检测其抑菌圈直径范围为6. 50～19. 75 mm,二者显著相关(P<0. 01,r=-0. 836)。结论:本地区儿童肠道感染的非伤寒沙门菌血清型多样,以小婴儿为主,多重耐药菌比例较高;检出的非伤寒沙门菌对阿奇霉素的基础数据可以作为以后临床应用的参考指标。
Objective: To investigate the epidemiological characteristics of non-typhoid Salmonellosis(NTS) infection in children in this region,monitor its sensitivity to antibiotics,and explore the possibility of azithromycin in the treatment of intestinal NTS infection,so as to provide scientific basis for further control of NTS infection. Methods: A retrospective analysis was made on the epidemiological characteristics in terms of the age,gender and onset season in 76 children with NTS infection in Shenzhen Children's Hospital from July2014 to June 2016. The sensitivity of five commonly used antibiotics was detected by K-B method. The minimum inhibitory concentration(MIC) of azithromycin was detected by E-Test method and K-B method,and the MIC value of azithromycin and its inhibition zone diameter linear regression were analyzed. Results: The 76 strains of NTS belonged to 4 serotypes,and Salmonella typhimurium serotype and Salmonella enteritidis serotype were the main serotypes. Totally 54 infants were under 1 year old,accounting for 71. 05%. The sensitivity of NTS to compound trimoxazole,ceftriaxone,chloramphenicol,nalidixic acid and ampicillin were 73. 68%,63. 16%,60. 53%,27. 63% and 22. 37%,respectively. There were 16 strains of multi-drug resistant NSP,accounting for 21. 05%. MIC of azithromycin by using E-TEST was from 2 to 96 μg/m L,3 μg/m L for MIC50 and 4 μg/m L for MIC90. The diameter of the inhibition zone was determined by the disc diffusion method to be from 6. 50 to 19. 75 mm,which was significantly correlated(P<0. 01,r =-0. 836). Conclusion: NTS infection in children in this region are diverse,mainly in infants,with a high proportion of multi-drug resistance. The basic data of the detection of NTS against azithromycin can be used as a reference index for future clinical application.
Objective: To investigate the epidemiological characteristics of non-typhoid Salmonellosis(NTS) infection in children in this region,monitor its sensitivity to antibiotics,and explore the possibility of azithromycin in the treatment of intestinal NTS infection,so as to provide scientific basis for further control of NTS infection. Methods: A retrospective analysis was made on the epidemiological characteristics in terms of the age,gender and onset season in 76 children with NTS infection in Shenzhen Children's Hospital from July2014 to June 2016. The sensitivity of five commonly used antibiotics was detected by K-B method. The minimum inhibitory concentration(MIC) of azithromycin was detected by E-Test method and K-B method,and the MIC value of azithromycin and its inhibition zone diameter linear regression were analyzed. Results: The 76 strains of NTS belonged to 4 serotypes,and Salmonella typhimurium serotype and Salmonella enteritidis serotype were the main serotypes. Totally 54 infants were under 1 year old,accounting for 71. 05%. The sensitivity of NTS to compound trimoxazole,ceftriaxone,chloramphenicol,nalidixic acid and ampicillin were 73. 68%,63. 16%,60. 53%,27. 63% and 22. 37%,respectively. There were 16 strains of multi-drug resistant NSP,accounting for 21. 05%. MIC of azithromycin by using E-TEST was from 2 to 96 μg/m L,3 μg/m L for MIC50 and 4 μg/m L for MIC90. The diameter of the inhibition zone was determined by the disc diffusion method to be from 6. 50 to 19. 75 mm,which was significantly correlated(P<0. 01,r =-0. 836). Conclusion: NTS infection in children in this region are diverse,mainly in infants,with a high proportion of multi-drug resistance. The basic data of the detection of NTS against azithromycin can be used as a reference index for future clinical application.
引文
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[10]MATONO T,KATO Y,MORITA M,et al. Case series of imported enteric fever at a referral center in Tokyo,Japan:antibiotic susceptibility and risk factors for relapse[J]. Am J Trop Med Hyg,2016,95(1):19-25.
[11]MALIK N,AHMED M. In vitro effect of new antibiotics against clinical isolates of Salmonella typhi[J]. J Coll Physicians Surg Pak,2016,26(4):288-292.
[12]OEY M, MALHOTRA P. Azithromycin and ceftriaxone combination treatment for relapsed Salmonella paratyphi A bacteraemia[J]. J Travel Med,2016,23(2):tav032.
[13]FALAY D, KUIJPERS L M, PHOBA M F, et al.Microbiological,clinical and molecular findings of non-typhoidal Salmonella bloodstream infections associated with malaria,Oriental Province,Democratic Republic of the Congo[J]. BMC Infect Dis,2016,16(1):271-285.
[14]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.
[15]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.
[16]BUTT F, SULTAN F. In vitro activity of azithromycin in Salmonella isolates from Pakistan[J]. J Infect Dev Ctries,2011,5(5):391-395.
[2]MANDOMANDO I,BASSAT Q,SIGAUQUE B,et al. Invasive Salmonella infections among children from rural Mozambique,2001-2014[J]. Clin Infect Dis,2015,61(Suppl 4):S339-S345.
[3]PHOBA M F,DE BOECK,IFEKA B B,et al. Epidemic increase in Salmonella bloodstream infection in children,Bwamanda,the Democratic Republic of Congo[J]. Eur J Clin Microbiol Infect Dis,2014,33(1):79-87.
[4]CHINNASAMI B,SADASIVAM K,VIVEKANANDHAN A,et al. A study on longevity of immune response after vaccination with Salmonella Typhi Vi conjugate vaccine(Pedatyph)in children[J]. J Clin Diagn Res,2015,9(5):SC01-SC03.
[5]BULA-RUDAS F J,RATHORE M H,MARAQA N F. Salmonella infections in childhood[J]. Adv Pediatr,2015,62(1):29-58.
[6]MULATU G, BEYENE G, ZEYNUDIN A. Prevalence of Shigella, Salmonella and Campylobacter species and their susceptibility patters among under five children with diarrhea in Hawassa town,south Ethiopia[J]. Ethiop J Health Sci,2014,24(2):101-108.
[7]MELTZER E, STIENLAUF S, LESHEM E, et al. A large outbreak of Salmonella Paratyphi A infection among Israeli travelers to Nepal[J]. Clin Infect Dis,2014,58(3):359364.
[8]WONG M H,YAN M,CHAN E W,et al. Emergence of clinical Salmonella enterica serovar Typhimurium isolates with concurrent resistance to ciprofloxacin,ceftriaxone,and azithromycin[J].Antimicrob agents chemother,2014,58(7):3752-3756.
[9]GUNELL M,KOTILAINEN P,JALAVA J,et al. In vitro activity of azithromycin against nontyphoidal Salmonella enteric[J].Antimicrob agents chemother,2010,54(8):3498-3501.
[10]MATONO T,KATO Y,MORITA M,et al. Case series of imported enteric fever at a referral center in Tokyo,Japan:antibiotic susceptibility and risk factors for relapse[J]. Am J Trop Med Hyg,2016,95(1):19-25.
[11]MALIK N,AHMED M. In vitro effect of new antibiotics against clinical isolates of Salmonella typhi[J]. J Coll Physicians Surg Pak,2016,26(4):288-292.
[12]OEY M, MALHOTRA P. Azithromycin and ceftriaxone combination treatment for relapsed Salmonella paratyphi A bacteraemia[J]. J Travel Med,2016,23(2):tav032.
[13]FALAY D, KUIJPERS L M, PHOBA M F, et al.Microbiological,clinical and molecular findings of non-typhoidal Salmonella bloodstream infections associated with malaria,Oriental Province,Democratic Republic of the Congo[J]. BMC Infect Dis,2016,16(1):271-285.
[14]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.
[15]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.
[16]BUTT F, SULTAN F. In vitro activity of azithromycin in Salmonella isolates from Pakistan[J]. J Infect Dev Ctries,2011,5(5):391-395.