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.
引文
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