2013-2017年浙江省温州市产超广谱β-内酰胺酶沙门菌的血清型及耐药性分析
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摘要
目的研究2013—2017年温州地区产超广谱β-内酰胺酶(ESBLs)沙门菌的血清型分布及耐药性,为临床病情的预防、诊断与治疗提供依据。方法对2013年1月至2017年12月本单位及各区疾病预防控制中心上送的294株沙门菌菌株进行E-test定量法确认产ESBLs菌株的血清分型、药物敏感性及其流行病学特征分析。结果 294株沙门菌筛查出产ESBLs菌株68株,检出率为23.13%,共有3种血清型。产ESBLs鼠伤寒沙门菌41株(60.29%,41/68)、产ESBLs肠炎沙门菌19株(27.94%,19/68)、产ESBLs德比沙门菌8株(11.76%,8/68)。患者年龄以3～5岁幼儿(61.76%,42/68)和0～2岁婴儿(17.65%,12/68)为主。而标本类型以肠道标本为主,占69.12%(47/68),其次来源自血液,占30.88%(21/68)。产ESBLs沙门菌对头孢吡肟、复方新诺明、四环素的耐药率分别为41.18%、52.94%和47.06%;未发现亚胺培南、环丙沙星、左氧氟沙星耐药株。结论产ESBLs沙门菌菌株传播较严重,主要血清型为鼠伤寒沙门菌,在婴幼儿中多见;产ESBLs沙门菌对抗生素耐药性不同,尤其头孢吡肟、复方新诺明、四环素等敏感性较差,临床上应加强多重耐药监控。
Objective To study the serotype distribution and drug resistance characteristics of ESBLs-producing Salmonella in Wenzhou,Zhejiang province,from 2013 to 2017 and provide evidence for the disease prevention,diagnosis and treatment in clinical practice.Methods From January 2013 to December 2017,a total of 294 Salmonella strains were collected from our hospital and all the district centers for disease control and prevention in Wenzhou,and the serotypes of ESBLs-producing Salmonella strains were confirmed by E-test quantitative analysis.The drug sensitivity and epidemiological characteristics of the strains were analyzed.Results The screening of 294 strains of Salmonella found 68(23.13%) ESBLs-producing strains,involving three serotypes and including 41(60.29%,41/68) Salmonella typhimurium strains,19(27.94%,19/68) Salmonella enteritis strains and 8(11.76%,8/68) Salmonella derby strains.The cases were mainly children aged 3–5 years(61.76%,42/68)and infants aged 0–2 years(17.65%,12/68).The clinical samples were mainly intestinal samples,accounting for 69.12%(47/68),followed by blood samples,accounting for 30.88%(21/68).The resistant rate of ESBLs producing Salmonella was41.18% to cefepime,52.94% to compound sulfamethoxazole and 47.06% to tetracycline.No strains which were resistant to imipenem,ciprofloxacin and levofloxacin were found.Conclusion The transmission of ESBLs-producing Salmonella was serious in Wenzhou,the major serotype was Salmonella typhimurium,which were mainly detected in infants.ESBLsproducing Salmonella has different resistance to antibiotics,especially the poor sensitivities to cefepime,compound sulfamethoxazole,tetracycline,etc.Multidrug resistance monitoring should be strengthened in clinical practice.
Objective To study the serotype distribution and drug resistance characteristics of ESBLs-producing Salmonella in Wenzhou,Zhejiang province,from 2013 to 2017 and provide evidence for the disease prevention,diagnosis and treatment in clinical practice.Methods From January 2013 to December 2017,a total of 294 Salmonella strains were collected from our hospital and all the district centers for disease control and prevention in Wenzhou,and the serotypes of ESBLs-producing Salmonella strains were confirmed by E-test quantitative analysis.The drug sensitivity and epidemiological characteristics of the strains were analyzed.Results The screening of 294 strains of Salmonella found 68(23.13%) ESBLs-producing strains,involving three serotypes and including 41(60.29%,41/68) Salmonella typhimurium strains,19(27.94%,19/68) Salmonella enteritis strains and 8(11.76%,8/68) Salmonella derby strains.The cases were mainly children aged 3–5 years(61.76%,42/68)and infants aged 0–2 years(17.65%,12/68).The clinical samples were mainly intestinal samples,accounting for 69.12%(47/68),followed by blood samples,accounting for 30.88%(21/68).The resistant rate of ESBLs producing Salmonella was41.18% to cefepime,52.94% to compound sulfamethoxazole and 47.06% to tetracycline.No strains which were resistant to imipenem,ciprofloxacin and levofloxacin were found.Conclusion The transmission of ESBLs-producing Salmonella was serious in Wenzhou,the major serotype was Salmonella typhimurium,which were mainly detected in infants.ESBLsproducing Salmonella has different resistance to antibiotics,especially the poor sensitivities to cefepime,compound sulfamethoxazole,tetracycline,etc.Multidrug resistance monitoring should be strengthened in clinical practice.
引文
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[6]张秀丽,廖兴广,郝宗宇,等.2006-2007年河南省生肉食品中沙门菌的主动监测及其DNA指纹图谱库的建立[J].中国卫生检验杂志,2009,19(7):1545-1548.Zhang XL,Liao XG,Hao ZY,et al.Pro-active monitoring and establishment of DNA fingerprint database of Salmonella in raw meat food in Henan province during 2006-2007[J].Chin J Health Lab Technol,2009,19(7):1545-1548.
[7]厉小玉,岳美娜,王云桥,等.2008-2012年杭州市儿童感染性腹泻的志贺菌和沙门菌变迁及耐药性分析[J].疾病监测,2014,29(5):364-368.DOI:10.3784/j.issn.1003-9961.2014.05.008.Li XY,Yue MN,Wang YQ,et al.Salmonella and Shigella caused infectious diarrhea in children and pathogens'drug resistance in Hangzhou,Zhejiang,2008-2012[J].Dis Surveill,2014,29(5):364-368.DOI:10.3784/j.issn.1003-9961.2014.05.008.
[8]周煜,郑伟,陈建才,等.杭州市2013年沙门菌流行特征及分子分型研究[J].中华流行病学杂志,2015,36(8):907-909.DOI:10.3760/cma.j.issn.0254-6450.2015.08.030.Zhou Y,Zheng W,Chen JC,et al.Epidemiological characteristics and molecular typing of Salmonella in Hangzhou in 2013[J].Chin J Epidemiol,2015,36(8):907-909.DOI:10.3760/cma.j.issn.0254-6450.2015.08.030.
[9]杨燕.浙江省沙门菌的分子分型和流行病学研究[D].杭州:浙江大学,2014.Yang Y.Study on the epidemiological characters and molecular typing of Salmonella in Zhejiang province[D].Hangzhou:Zhejiang University,2014.
[10]岳美娜,厉小玉,刘荻,等.杭州地区儿童感染沙门菌产超广谱β-内酰胺酶基因型及耐药谱探讨[J].中国卫生检验杂志,2017,27(4):594-597.Yue MN,Li XY,Liu D,et al.Discussion on the extendedspectrum beta-lactamases-producing genotypes and antimicrobial resistance patterns of Salmonella strains isolated from children in Hangzhou[J].Chin J Health Lab Technol,2017,27(4):594-597.
[11]朱传新,钭慧芬,郑文力,等.温州地区沙门菌的耐药情况研究[J].中国卫生检验杂志,2016,26(2):283-286.Zhu CX,Tou HF,Zheng WL,et al.Research on drug resistance of Salmonella in Wenzhou[J].Chin J Health Lab Technol,2016,26(2):283-286.
[12]郭宝俊,曹小燕,何昱苇.135株鼠伤寒沙门菌耐药酶检测及药物敏感性分析[J].中华医院感染学杂志,2011,21(20):4396-4398.Guo BJ,Cao XY,He YW.Detection of drug resistant enzyme produced by 135 strains of Salmonlla typhimurium and analysis of drug sensitivity analysis[J].Chin J Nosocomiol,2011,21(20):4396-4398.
[13]Siu LK,Lo JYC,Yuen KY,et al.β-lactamases in Shigella flexneri isolates from Hong Kong and Shanghai and a novel OXA-1-likeβ-lactamases,OXA-30[J].Antimicrob Agents Chemother,2000,44(8):2034-2038.DOI:10.1128/AAC.44.8.2034-2038.2000.
[2]贺连华,吴平芳,陈妙玲,等.2010-2013年深圳市食品中沙门菌血清分型及耐药分析[J].中国卫生检验杂志,2015,25(1):289-291,294.He LH,Wu PF,Chen ML,et al.Serotyping and drug resistance analysis of Salmonella in foodin Shenzhen from 2010 to 2013[J].Chin J Health Lab Tec,2015,25(1):289-291,294.
[3]孙晓雷,冒群,练维,等.南通地区伤寒沙门菌质粒介导的耐药性转移的初步研究[J].中国抗生素杂志,2013,38(2):159-163.DOI:10.3969/j.issn.1001-8689.2013.02.015.Sun XL,Mao Q,Lian W,et al.The study of antibiotic resistance profiles of Salmonella isolated in Nantong and characterization molecule mechnism[J].Chin J Antibiot,2013,38(2):159-163.DOI:10.3969/j.issn.1001-8689.2013.02.015.
[4]Murray PR,Pfaller MA,Tenover FC.临床微生物学手册[M].徐建国,译.北京:科学出版社,2005:2209-2224.Murray PR,Pfaller MA,Tenover FC.Mannual of clinical microbiology[M].Xu JG,trans.Beijing:Science Press,2005:2209-2224.
[5]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.DOI:10.16718/j.1009-7708.2016.03.009.Xu YM,Du Y,Shan B,et al.Resistance profile of Salmonella isolates in hospital across China:results from CHINETantimicrobial resistance surveillance program,2005-2014[J].Chin J Infect Chemother,2016,16(3):294-301.DOI:10.16718/j.1009-7708.2016.03.009.
[6]张秀丽,廖兴广,郝宗宇,等.2006-2007年河南省生肉食品中沙门菌的主动监测及其DNA指纹图谱库的建立[J].中国卫生检验杂志,2009,19(7):1545-1548.Zhang XL,Liao XG,Hao ZY,et al.Pro-active monitoring and establishment of DNA fingerprint database of Salmonella in raw meat food in Henan province during 2006-2007[J].Chin J Health Lab Technol,2009,19(7):1545-1548.
[7]厉小玉,岳美娜,王云桥,等.2008-2012年杭州市儿童感染性腹泻的志贺菌和沙门菌变迁及耐药性分析[J].疾病监测,2014,29(5):364-368.DOI:10.3784/j.issn.1003-9961.2014.05.008.Li XY,Yue MN,Wang YQ,et al.Salmonella and Shigella caused infectious diarrhea in children and pathogens'drug resistance in Hangzhou,Zhejiang,2008-2012[J].Dis Surveill,2014,29(5):364-368.DOI:10.3784/j.issn.1003-9961.2014.05.008.
[8]周煜,郑伟,陈建才,等.杭州市2013年沙门菌流行特征及分子分型研究[J].中华流行病学杂志,2015,36(8):907-909.DOI:10.3760/cma.j.issn.0254-6450.2015.08.030.Zhou Y,Zheng W,Chen JC,et al.Epidemiological characteristics and molecular typing of Salmonella in Hangzhou in 2013[J].Chin J Epidemiol,2015,36(8):907-909.DOI:10.3760/cma.j.issn.0254-6450.2015.08.030.
[9]杨燕.浙江省沙门菌的分子分型和流行病学研究[D].杭州:浙江大学,2014.Yang Y.Study on the epidemiological characters and molecular typing of Salmonella in Zhejiang province[D].Hangzhou:Zhejiang University,2014.
[10]岳美娜,厉小玉,刘荻,等.杭州地区儿童感染沙门菌产超广谱β-内酰胺酶基因型及耐药谱探讨[J].中国卫生检验杂志,2017,27(4):594-597.Yue MN,Li XY,Liu D,et al.Discussion on the extendedspectrum beta-lactamases-producing genotypes and antimicrobial resistance patterns of Salmonella strains isolated from children in Hangzhou[J].Chin J Health Lab Technol,2017,27(4):594-597.
[11]朱传新,钭慧芬,郑文力,等.温州地区沙门菌的耐药情况研究[J].中国卫生检验杂志,2016,26(2):283-286.Zhu CX,Tou HF,Zheng WL,et al.Research on drug resistance of Salmonella in Wenzhou[J].Chin J Health Lab Technol,2016,26(2):283-286.
[12]郭宝俊,曹小燕,何昱苇.135株鼠伤寒沙门菌耐药酶检测及药物敏感性分析[J].中华医院感染学杂志,2011,21(20):4396-4398.Guo BJ,Cao XY,He YW.Detection of drug resistant enzyme produced by 135 strains of Salmonlla typhimurium and analysis of drug sensitivity analysis[J].Chin J Nosocomiol,2011,21(20):4396-4398.
[13]Siu LK,Lo JYC,Yuen KY,et al.β-lactamases in Shigella flexneri isolates from Hong Kong and Shanghai and a novel OXA-1-likeβ-lactamases,OXA-30[J].Antimicrob Agents Chemother,2000,44(8):2034-2038.DOI:10.1128/AAC.44.8.2034-2038.2000.