临床药师参与 1 例鼠伤寒沙门菌肠炎患儿抗感染治疗的药学实践

目的:对临床药师参与的 1 例鼠伤寒沙门菌肠炎患儿的抗感染治疗进行分析,为提高患儿的用药安全提供参考。 方法:临床药师通过查阅文献得知鼠伤寒沙门菌感染性腹泻治愈后,通过粪便的排菌周期较长,建议临床医师及时停用抗菌药物,避免恢复期长期使用抗菌药物延长患儿的排菌周期,增加药物不良反应,甚至引发二重感染。 结果:临床医师采纳药师建议,停用抗菌药物,住院期间未观察到明显药物不良反应。 结论:临床药师应关注鼠伤寒沙门菌肠炎患儿的抗感染治疗疗程,提高患儿用药安全性。     

Effect of an Enterococcus faecium probiotic on specific IgA following live Salmonella Enteritidis vaccination of layer chickens

Probiotics and immunization are being widely adopted by the poultry industry with the goal of controlling Salmonella enterica. However, the interaction between these two management protocols has been sparsely studied. The present study aimed to understand the role of an Enterococcus faecium probiotic in the production of salmonella-specific IgA in layers immunized with a live vaccine. Four groups were used: “Control” (no vaccine or probiotic); “Probiotic” (which received an E. faecium product); “Vaccine” (immunized with two doses of a live attenuated S. Enteritidis vaccine); and “Vaccine?+?probiotic”. Faecal salmonella-specific IgA was analysed 7 and 20 days post-vaccination (dpv) boost. At 7 dpv, the “Vaccine” and “Vaccine?+?probiotic” groups had similar IgA levels. However, at 20 dpv, IgA levels were two times higher in the “Vaccine?+?probiotic” group compared to the “Vaccine” group. To understand the role of the intestinal microbiota in this finding, bacterial diversity in faeces was analysed by 16S rRNA gene sequencing. The improvement in IgA production in probiotic-treated birds was accompanied by marked changes in the faecal microbiome. Some of the main differences between the “Vaccine” and “Vaccine?+?probiotic” groups included reduction of Escherichia-Shigella and increases in Blautia, Anaerotruncus and Lactobacillus in the latter group. Although no direct causal link can be established from this study design, it is possible that the E. faecium probiotic induces improved antibody production following vaccination via modulation of the intestinal microbiota.     

Review of egg-related salmonellosis and reduction strategies in United States,Australia, United Kingdom and New Zealand

Globally, Salmonella enterica subsp. enterica is one of the most commonly reported causes of foodborne illness in humans. Contaminated food products of animal origin, particularly egg and egg products are frequently implicated in outbreaks of human salmonellosis. Salmonella enteritidis is frequently involved in egg and egg products-associated foodborne outbreaks in the USA and UK. However, in Australia and New Zealand, human infections caused by this serovar occur as a result of infection acquired while overseas travel, with Salmonella typhimurium being a predominant cause of local foodborne outbreaks. In this paper, an overview of Salmonella epidemiology on laying farms, egg-related Salmonella outbreaks in humans, and regulatory practises to control Salmonella across USA, UK, Australia and New Zealand is provided. Considering the estimated production of eggs in the USA, UK, Australia and New Zealand in 2015, the risk of foodborne illness in general is quite low for humans consuming eggs. Salmonella diagnostics, reporting and surveillance systems have improved over the years and will continue to improve in the years to come. However, given the number of different emerging Salmonella serovars a regular review of Salmonella control strategies from farm to fork is required.     

耐三代头孢菌素沙门菌的耐药基因分析

目的了解耐三代头孢菌素沙门菌的耐药基因分布特征,为疾病的防控和治疗提供依据。方法选取对头孢噻肟(CTX)和(或)头孢他啶(CAZ)耐药的临床分离的沙门菌157株,进行血清学分型和超广谱β-内酰胺酶(ESBLs)确证试验,采用PCR方法检测7种β-内酰胺类耐药基因。结果157株沙门菌中,分布有20种血清型,以鼠伤寒沙门菌和肠炎沙门菌为主。共127株检出耐药基因,检出率为80.89%,包括bla_TEM103株、bla_CTX-M79株、bla_OXA-109株和bla_SHV1株,未检出bla_PER、bla_CMY和bla_ACC。ESBLs阳性80株,占50.96%;其中23株(28.75%)检出1种耐药基因,50株(62.50%)检出2种耐药基因,7株(8.75%)检出3种耐药基因;携带的耐药基因模式以bla_CTX-M-1G+bla_TEM(35株)、bla_CTX-M-9G+bla_TEM(14株)和bla_CTX-M-9G(12株)多见。ESBLs阴性77株,占49.04%;其中46株(59.74%)检出1种耐药基因,1株(1.30%)检出2种耐药基因,30株(38.96%)未检出耐药基因;携带的耐药基因模式以bla_TEM(46株)为主。对CTX耐药的沙门菌和对CTX不耐药的沙门菌bla_CTX-M的检出率差异有统计学意义(χ²=83.366,P=0.000)。对CAZ耐药的沙门菌和对CAZ不耐药的沙门菌bla_TEM检出率差异无统计学意义(χ²=0.268,P=0.384)。鼠伤寒沙门菌和肠炎沙门菌bla_CTX-M-1G和bla_CTX-M-9G的携带率差异有统计学意义(χ²=6.285,P=0.012;χ²=8.735,P=0.003)。bla_TEM在表型为CAZ耐药、CTX敏感或中介组,CTX耐药、CAZ敏感或中介组及CAZ和CTX均耐药组中的携带率差异无统计学意义(χ²=0.270,P=0.874)。结论耐三代头孢菌素沙门菌携带的耐药基因以bla_TEM和bla_CTX-M为主,同时伴有bla_OXA-10和bla_SHV,呈多样性,需要持续监测和研究。     

社区蛋糕店一起沙门氏菌食物中毒事件的流行病学调查

目的 对发生在社区蛋糕店的一起食物中毒事件进行流行病学调查分析,查明致病因子、致病食品及其污染来源,为今后预防类似事件的发生提供参考。 方法 采用现场流行病学调查、食品卫生学调查和实验室检验相结合的方法。 结果 本次事件共发现病例14例,病例的临床表现相似,主要为腹泻、腹痛、发热、呕吐。发病潜伏期中位数为9.25 h(3.2~14.6 h)。所有病例发病前均食用过HG糕店制售的三文治,经剂量反应关系分析,认为三文治食用量和疾病严重程度存在相关性 (r=0.583,P=0.029)。病例肛拭子、呕吐物及粪便、剩余三文治和三文治生产原料等标本中均检出肠炎沙门氏菌,不同来源标本中分离到的阳性菌株经脉冲场凝胶电泳(pulsed-field gel electrophoresis,PFGE)分子分型分析具有同源性。 结论 该起事件是一起因食用社区蛋糕店制售的受沙门氏菌污染的三文治引起的食物中毒事件。     

伤寒沙门氏菌耐药性与外膜蛋白关系的研究

对临床分离的２６株伤寒沙门氏菌进行了外膜蛋白，质粒，药物敏感试验及氯霉素乙酰基转移酶（ＣＡＴ）活性测定。结果显示：２６株菌中有８株耐氯霉素，其中７株对氯霉素等４种抗生素高度耐药（ＭＩＣ＞２００μｇ／ｍｌ），均含９８．６Ｍｄ大质粒，１株对氯霉素敏感而耐氨苄青霉素的菌株亦含该质粒。８株菌除１株外其氯霉素乙酰转移酶活性均为阳性。外膜蛋白指纹图谱示伤寒沙门氏菌均含５２、３８、３７、３６ＫＤ主蛋白，其中有３株耐药菌３７ＫＤ蛋白含量减少或缺失，实验表明伤寒沙门氏菌耐药性与质粒相关，ＣＡＴ由质粒调控，个别菌株存在非酶性耐药，可能与外膜蛋白的减少或缺失有关。     

搭桥法诱导肠炎沙门氏菌鞭毛抗原及鉴定

目的：了解搭桥法对诱导肠炎沙门氏菌鞭毛的临床意义。方法：从2013年4～6月两次食物中毒事件中分离获得7株具有典型生化反应、O-抗原为D群但缺失鞭毛抗原的沙门氏菌。采用搭桥法对7株菌株进行诱导培养,使其鞭毛抗原成功恢复。结果：综合该菌的生物学特性、生化反应及血清学试验得到准确的种属及血清型鉴定。结论：该菌鞭毛抗原的成功诱导为肠炎沙门氏菌的血清型鉴定提供了参考,为基层实验室开展沙门氏菌的血清学检验鉴定提供省时、简单、高效的方法,具有积极意义。