1984-2016年福建省人源与食源性沙门菌血清分型和耐药特征研究
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摘要
目的研究福建省人源和食源性沙门菌血清型和耐药特征。方法追溯1984—2016年福建省内临床、健康体检者和食源性沙门菌株,使用世界卫生组织推荐的沙门菌血清分型方法进行回顾性鉴定。通过纸片扩散法测试菌株对10种抗生素的敏感性,使用χ2检验对结果进行分类统计。结果复核人源和食源沙门菌1 406株,覆盖17个血清群(患者源16个、健康者携带源9个、食源性8个),确认伤寒、甲型副伤寒和猪霍乱沙门菌为肠道外感染的侵袭性血清型,确认除伤寒、甲型副伤寒和乙型副伤寒以外的非伤寒/副伤寒沙门菌65个血清型(患者源49个、健康者携带源46个、食源性27个),数量较多的前5位血清型分别为鼠伤寒、肠炎、德比、斯坦利和韦太夫雷登,临床感染优势血清型分别为鼠伤寒、肠炎、斯坦利、猪霍乱和德比,经验证和比对确认人源中5个和食品源中3个血清型为国内首次分离菌型。健康人携带和食源性沙门菌的血清群、血清型分布和耐药谱接近,多重耐药(MDR)率显著低于患者来源株(χ2=191.675,P<0.001),患者源沙门菌对环丙沙星和三代头孢耐药率均低于10%,MDR率较高,占51.00%。甲型副伤寒和鼠伤寒、肠炎沙门菌分别为伤寒/副伤寒、非伤寒/副伤寒沙门菌中耐药率较高和MDR率高的血清型。结论福建省人源沙门菌较食源性沙门菌有更广泛的生物多样性,人源沙门菌耐药率高于食源性沙门菌。建议加强对临床侵袭性感染病例和食品–环境–人群的整合行为生态传染病导致暴发疫情的防控。
Objective To study the drug resistance characteristics and serotype spectrum of Salmonella isolates from human and food sources in Fujian province. Methods By using the methods and materials of Salmonella serotyping recommend by WHO, a retrospective serotype identification was conducted for the Salmonella strains of clinical, health carrier and food sources in Fujian from 1984 to 2016. The resistance of the strains to 10 antibiotics was tested with disk diffusion method. Chisquare test was used to analyze categorical variables. Results A total of 1 406 Salmonella strains of human and food sources were re-identified by the reference laboratory, including 17 serogroups in 16 clinical isolates, 9 isolates from healthy carriers and 8 food source isolates. S. Typhi, Paratyphi A and Choleraesuis were identified as invasive serotypes of infection. In addition to S. Typhi, Paratyphi A and B, the non-typhoidal Salmonella strains were confirmed to have 65 serotypes in 49 clinical isolates, 46 isolates from healthy carriers and 27 food source isolates. The top five serotypes of non-typhoidal Salmonella were S. Typhimurium, S. Enteritidis, S. Derby, S. Stanley and S. Weltevreden, while the predominant serotypes of clinical isolates were S. Typhimurium, S. Enteritidis, S. Stanley, S. Choleraesuis and S. Derby. Five human serotypes and 3 food source serotypes were isolated for the first time in China. The distribution of serogroups, serotypes and antibiotic resistance spectrum of Salmonella spp. of the isolates from healthy carriers were similar to those of food source isolates, and their multidrug resistance(MDR) rates were significantly lower than that of Salmonella spp. of clinical isolates(χ2=191.675,P<0.001). Resistant rates to ciprofloxacin and the third-generation cephalosporin in Salmonella from patients were less than 10%, but MDR rate was high(51.00%). S. Paratyphi A and S. Typhimurium, S. Enteritidis were the representatives of isolates with higher level drug resistance or MDR in S. Typhi/Paratyphi and non-typhoidal Salmonella, respectively.Conclusion Salmonellae of human source had a wider variety of biological diversity compared with Salmonellae of food source in Fujian, and the antibiotic resistance rate of Salmonellae of human source was higher than that of Salmonellae of food source. It is suggested to strengthen the prevention and control of the outbreak of invasive infectious diseases and behavioral and ecological infectious diseases.
Objective To study the drug resistance characteristics and serotype spectrum of Salmonella isolates from human and food sources in Fujian province. Methods By using the methods and materials of Salmonella serotyping recommend by WHO, a retrospective serotype identification was conducted for the Salmonella strains of clinical, health carrier and food sources in Fujian from 1984 to 2016. The resistance of the strains to 10 antibiotics was tested with disk diffusion method. Chisquare test was used to analyze categorical variables. Results A total of 1 406 Salmonella strains of human and food sources were re-identified by the reference laboratory, including 17 serogroups in 16 clinical isolates, 9 isolates from healthy carriers and 8 food source isolates. S. Typhi, Paratyphi A and Choleraesuis were identified as invasive serotypes of infection. In addition to S. Typhi, Paratyphi A and B, the non-typhoidal Salmonella strains were confirmed to have 65 serotypes in 49 clinical isolates, 46 isolates from healthy carriers and 27 food source isolates. The top five serotypes of non-typhoidal Salmonella were S. Typhimurium, S. Enteritidis, S. Derby, S. Stanley and S. Weltevreden, while the predominant serotypes of clinical isolates were S. Typhimurium, S. Enteritidis, S. Stanley, S. Choleraesuis and S. Derby. Five human serotypes and 3 food source serotypes were isolated for the first time in China. The distribution of serogroups, serotypes and antibiotic resistance spectrum of Salmonella spp. of the isolates from healthy carriers were similar to those of food source isolates, and their multidrug resistance(MDR) rates were significantly lower than that of Salmonella spp. of clinical isolates(χ2=191.675,P<0.001). Resistant rates to ciprofloxacin and the third-generation cephalosporin in Salmonella from patients were less than 10%, but MDR rate was high(51.00%). S. Paratyphi A and S. Typhimurium, S. Enteritidis were the representatives of isolates with higher level drug resistance or MDR in S. Typhi/Paratyphi and non-typhoidal Salmonella, respectively.Conclusion Salmonellae of human source had a wider variety of biological diversity compared with Salmonellae of food source in Fujian, and the antibiotic resistance rate of Salmonellae of human source was higher than that of Salmonellae of food source. It is suggested to strengthen the prevention and control of the outbreak of invasive infectious diseases and behavioral and ecological infectious diseases.
引文
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[6]菌学联盟.舌尖中国之沙门菌的食菌同源:祝贺菌学联盟丁酉年岁末公开已收录的133种沙门菌血清型[EB/OL].(2018-02-11)[2018-04-10].https://mp.weixin.qq.com/s/KONB5Ho KMMJs H_AXy DG9g Q.Bacterium-learning Union.The Salmonella serotyping homology from humans and food source caused of the tip of the tongue in China-Congratulations to Bacterium-learning Union published 133kinds of Salmonella serotype at the end of the year[EB/OL].(2018-02-11)[2018-04-10].https://mp.weixin.qq.com/s/KONB5Ho KMMJs H_AXy DG9g Q.
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[13]Chiu CH,Su LH,Chu C.Salmonella Enterica serotype Choleraesuis:epidemiology,pathogenesis,clinical disease,and treatment[J].Clin Microbiol Rev,2004,17(2):311-322.DOI:10.1128/CMR.17.2.311-322.2004.
[14]周玫,罗铭,陈峰,等.源于东南亚的韦太夫雷登沙门菌在全球的传播扩散[J].疾病监测,2016,31(1):73-81.DOI:10.3784/j.issn.1003-9961.2016.01.017.Zhou M,Luo M,Chen F,et al.Worldwide spread of Salmonella Enterica serovar Weltevreden originated from Southeast Asia[J].Dis Surveill,2016,31(1):73-81.DOI:10.3784/j.issn.1003-9961.2016.01.017.
[15]刁保卫,胡雪明,王传清,等.波摩那沙门菌耐药及分子流行病学特征研究[J].中华流行病学杂志,2014,35(7):842-847.DOI:10.3760/cma.j.issn.0254-6450.2014.07.019.Diao BW,Hu XM,Wang CQ,et al.Study on the molecular epidemiology and antibiotic resistance of Salmonella Enterica serovar Pomona[J].Clin J Epidemiol,2014,35(7):842-847.DOI:10.3760/cma.j.issn.0254-6450.2014.07.019.
[16]Liang ZM,Ke BX,Deng XL,et al.Serotypes,seasonal trends,and antibiotic resistance of non-typhoidal Salmonella from human patients in Guangdong province,China,2009-2012[J].BMCInfect Dis,2015,15:53.DOI:10.1186/s12879-015-0784-4.
[17]Karp BE,Tate H,Plumblee JR,et al.National antimicrobial resistance monitoring system:two decades of advancing public health through integrated surveillance of antimicrobial resistance[J].Foodborne Pathog Dis,2017,14(10):545-557.DOI:10.1089/fpd.2017.2283.
[18]Hsua SC,Chiu TH,Pang JC,et al.Characterisation of antimicrobial resistance patterns and class 1 integrons among Escherichia coli and Salmonella Enterica serovar Choleraesuis strains isolated from humans and swine in Taiwan[J].Int JAntimicrob Agents,2006,27(5):383-391.DOI:10.1016/j.ijantimicag.2005.11.020.
[19]Wang JY,Li YR,Xu XB,et al.Antimicrobial resistance of Salmonella Enterica serovar Typhimurium in Shanghai,China[J].Front Microbiol,2017,8:510.DOI:10.3389/fmicb.2017.00510.
[20]Mac Pherson DW,Gushulak BD,Baine WB,et al.Population mobility,globalization,and antimicrobial drug resistance[J].Emerg Infect Dis,2009,15(11):1727-1732.DOI:10.3201/eid1511.090419.
[21]朱水荣,张政,莫顺堂,等.浙江省伤寒、甲型副伤寒沙门菌耐药性监测分析[J].疾病监测,2003,18(4):139-141.DOI:10.3784/j.issn.1003-9961.2003.04.012.Zhu SR,Zhang Z,Mo ST,et al.The resistance surveillance of Salmonella Typhi and Paratyphi A in Zhejiang province[J].Dis Surveill,2003,18(4):139-141.DOI:10.3784/j.issn.1003-9961.2003.04.012.
[22]Deen J,Von Seidlein L,Andersen F,et al.Community-acquired bacterial bloodstream infections in developing countries in south and southeast Asia:a systematic review[J].Lancet Infect Dis,2012,12(6):480-487.DOI:10.1016/S1473-3099(12)70028-2.
[2]Majowicz SE,Musto J,Scallan E,et al.The global burden of nontyphoidal Salmonella gastroenteritis[J].Clin Infect Dis,2010,50(6):882-889.DOI:10.1086/649513.
[3]Gossner CM,Le Hello S,De Jong B,et al.Around the world in1 475 Salmonella geo-serotypes[J].Emerg Infect Dis,2016,22(7):1298-1302.DOI:10.3201/eid2207.141678.
[4]朱超,许学斌.沙门菌属血清型诊断[M].上海:同济大学出版社,2009.Zhu C,Xu XB.Serological diagnosis of Salmonella Species[M].Shanghai:Tongji University Press,2009.
[5]谢一俊,林成水,陈亢川,等.福建省近年首次检出沙门菌血清型(变种)型别分布[J].中国人兽共患病杂志,1995,11(1):18-21.Xie YJ,Lin CS,Chen KC,et al.Distribution of serotypes(Var.)of Salmonella discovered in Fujian province in recent years[J].Chin J Heal Z,1995,11(1):18-21.
[6]菌学联盟.舌尖中国之沙门菌的食菌同源:祝贺菌学联盟丁酉年岁末公开已收录的133种沙门菌血清型[EB/OL].(2018-02-11)[2018-04-10].https://mp.weixin.qq.com/s/KONB5Ho KMMJs H_AXy DG9g Q.Bacterium-learning Union.The Salmonella serotyping homology from humans and food source caused of the tip of the tongue in China-Congratulations to Bacterium-learning Union published 133kinds of Salmonella serotype at the end of the year[EB/OL].(2018-02-11)[2018-04-10].https://mp.weixin.qq.com/s/KONB5Ho KMMJs H_AXy DG9g Q.
[7]Clinical and Laboratory Standards Institute.Performance standards for antimicrobial susceptibility testing[S].Twenty-sixth informational supplement(M100-S21).Wayne,PA:Clinical and Laboratory Standards Institute,2016.
[8]Centers for Disease Control and Prevention.An atlas of Salmonella in the United States,1968-2011,laboratory-based enteric disease surveillance[R].Atlanta,Georgia:U.S.Department of Health and Human Services,CDC,2013:124-131.
[9]Lu X,Hu YF,Luo M,et al.MCR-1.6,a new MCR variant carried by an Inc P plasmid in a colistin-resistant Salmonella Enterica serovar Typhimurium isolate from a healthy individual[J].Antimicrob Agents Chemother,2017,61(5):e02632.DOI:10.1128/AAC.02632-16.
[10]Hendriksen RS,Mikoleit M,Carlson VP,et al.WHO global SalmSurv external quality assurance system for serotyping of Salmonella isolates from 2000 to 2007[J].J Clin Microb,2009,47(9):2729-2736.DOI:10.1128/JCM.02437-08.
[11]Centers for Disease Control and Prevention.National antimicrobial resistance monitoring system for enteric bacteria(NARMS):2010human isolates final report[R].Atlanta,Georgia:U.S.Department of Health and Human Services,CDC,2012.
[12]Ran L,Wu SY,Gao YJ,et al.Laboratory-based surveillance of nontyphoidal Salmonella infections in China[J].Foodborne Pathog Dis,2011,8(8):921-927.DOI:10.1089/fpd.2010.0827.
[13]Chiu CH,Su LH,Chu C.Salmonella Enterica serotype Choleraesuis:epidemiology,pathogenesis,clinical disease,and treatment[J].Clin Microbiol Rev,2004,17(2):311-322.DOI:10.1128/CMR.17.2.311-322.2004.
[14]周玫,罗铭,陈峰,等.源于东南亚的韦太夫雷登沙门菌在全球的传播扩散[J].疾病监测,2016,31(1):73-81.DOI:10.3784/j.issn.1003-9961.2016.01.017.Zhou M,Luo M,Chen F,et al.Worldwide spread of Salmonella Enterica serovar Weltevreden originated from Southeast Asia[J].Dis Surveill,2016,31(1):73-81.DOI:10.3784/j.issn.1003-9961.2016.01.017.
[15]刁保卫,胡雪明,王传清,等.波摩那沙门菌耐药及分子流行病学特征研究[J].中华流行病学杂志,2014,35(7):842-847.DOI:10.3760/cma.j.issn.0254-6450.2014.07.019.Diao BW,Hu XM,Wang CQ,et al.Study on the molecular epidemiology and antibiotic resistance of Salmonella Enterica serovar Pomona[J].Clin J Epidemiol,2014,35(7):842-847.DOI:10.3760/cma.j.issn.0254-6450.2014.07.019.
[16]Liang ZM,Ke BX,Deng XL,et al.Serotypes,seasonal trends,and antibiotic resistance of non-typhoidal Salmonella from human patients in Guangdong province,China,2009-2012[J].BMCInfect Dis,2015,15:53.DOI:10.1186/s12879-015-0784-4.
[17]Karp BE,Tate H,Plumblee JR,et al.National antimicrobial resistance monitoring system:two decades of advancing public health through integrated surveillance of antimicrobial resistance[J].Foodborne Pathog Dis,2017,14(10):545-557.DOI:10.1089/fpd.2017.2283.
[18]Hsua SC,Chiu TH,Pang JC,et al.Characterisation of antimicrobial resistance patterns and class 1 integrons among Escherichia coli and Salmonella Enterica serovar Choleraesuis strains isolated from humans and swine in Taiwan[J].Int JAntimicrob Agents,2006,27(5):383-391.DOI:10.1016/j.ijantimicag.2005.11.020.
[19]Wang JY,Li YR,Xu XB,et al.Antimicrobial resistance of Salmonella Enterica serovar Typhimurium in Shanghai,China[J].Front Microbiol,2017,8:510.DOI:10.3389/fmicb.2017.00510.
[20]Mac Pherson DW,Gushulak BD,Baine WB,et al.Population mobility,globalization,and antimicrobial drug resistance[J].Emerg Infect Dis,2009,15(11):1727-1732.DOI:10.3201/eid1511.090419.
[21]朱水荣,张政,莫顺堂,等.浙江省伤寒、甲型副伤寒沙门菌耐药性监测分析[J].疾病监测,2003,18(4):139-141.DOI:10.3784/j.issn.1003-9961.2003.04.012.Zhu SR,Zhang Z,Mo ST,et al.The resistance surveillance of Salmonella Typhi and Paratyphi A in Zhejiang province[J].Dis Surveill,2003,18(4):139-141.DOI:10.3784/j.issn.1003-9961.2003.04.012.
[22]Deen J,Von Seidlein L,Andersen F,et al.Community-acquired bacterial bloodstream infections in developing countries in south and southeast Asia:a systematic review[J].Lancet Infect Dis,2012,12(6):480-487.DOI:10.1016/S1473-3099(12)70028-2.