婴幼儿腹泻病原菌分布特点及药敏分析

目的：研究青岛市2013年儿童感染性腹泻的病原菌的分布、流行病学特征及对抗菌药物的敏感情况,为临床预防以及合理用药提供参考依据。方法对2013年1月~2013年12月临床初步诊断为感染性腹泻患儿的新鲜粪便标本进行细菌分离培养和血清分型鉴定,采用纸片扩散法进行药敏试验,并以免疫层析双抗体夹心法定性检测A群轮状病毒抗原。结果526份粪便培养共检出病原菌6种80株,检出率为15.2%（80/526）。检出沙门菌38株（47.5%）,志贺菌8株（10.0%）,致泻性大肠杆菌8株（10.0%）,金黄色葡萄球菌4株（5.0%）,铜绿假单胞菌19株（23.7%）,白假丝酵母菌3株（3.75%）。8株志贺菌7株为福氏志贺菌,1株鲍氏志贺菌。沙门菌和志贺菌的耐药率分别为氨苄西林（68.7%、76.9%）、复方新诺明（21.1%、38.5%）、环丙沙星（15.8%、15.4%）、头孢曲松（6.25%、15.3%）。526份标本中A群轮状病毒阳性107份。结论2013年青岛市儿童细菌性腹泻的病原菌以沙门菌为主,易感人群以2岁以下婴幼儿为主；而金黄色葡萄球菌感染以1岁以下婴儿为主；铜绿假单胞菌和白假丝酵母菌引起的腹泻主要是由于长期应用广谱抗生素使肠道菌群失调所导致；A群轮状病毒是引起婴幼儿秋冬季腹泻的主要病原。应规范临床用药,加强细菌耐药监测。

Distribution characteristics of pathogens associated with infectious diarrhea in children from Qingdao district in 2012 and its sensitivity analysis

Objective To investigate the distribution of pathogens causing infectious diarrhea in children from Qingdao district in 2013 and analyze epidemiological characteristics and corresponding drug-sensitivity, in order to guide clinical prevention and treatment. Methods Pathogens were isolated and identified from fresh faeces of children preliminarily diagnosed with infectious diarrhea from January 2013 to December 2013. Drug-sensitivity testing was performed using paper disc diffusion method, and rotaviruses of A group were identified qualitatively with double antibody sandwich method to detect viral antigen. Results 80 strains of pathogens belonging to six species were isolated from 526 samples of faeces with the detection rate of 15.2%（80/526）, including 38 strains of Salmonella （47.5%）, 8 strains of Shigella （10.0%）, 8 strains of diarrheogenic Escherichia coli （10.0%）, 4 strains of Staphylococcus aureus （5.0%）, 19 strains of Pseudomonas aeruginosa （23.7%） and 3 strains of Candidid albicans （3.75%）. 7 strains of Shigella belonged to S. flexneri, 1 strain of Shigella belonged to S. boydii. Drug-sensitivity testing showed that for Salmonella and Shigella, the rates of drug resistance are as follows, to ampicillin, 60.5%and 87.5%, to SMZ-TMP, 21.1%and 37.5%, to Ciprofloxacin, 15.8%and 25%, to Ceftriaxone, 21.1%and 25%, respectively. A total of 107 samples were positive for rotavirus of group A. Conclusion The main pathogens causing bacterial diarrhea in children from Qingdao distrinct in 2012 are Shigella, mainly infecting infants below two years old, while Staphylococcus aureus prefer to infect infants below one year old. And bacterial diarrhea caused by Pseudomonas aeruginosa and Candidid albicans are induced mostly by enteric dysbacteriosis owing to long-term use of broad-spectrum antibiotics. Rotavirus of group A is the most common pathogen causing diarrhea of infants in autumn and winter. Therefore, clinical usage of antibotics should be regulated towards standardization and drug resistance should be monitored regularly.