感染性腹泻临床与病原学分布特点及耐药分析

目的探讨新疆地区感染性腹泻的临床及病原学分布特点,指导经验性治疗感染性腹泻,避免滥用抗菌药物。方法回顾性分析2009年8～10月及2010年5～10月新疆医科大学第二附属医院肠道门诊感染性腹泻患者的临床及病原学特点、药敏结果。结果以急性腹泻为首发症状就诊的183例患者中,26例(14.2%)粪便细菌培养阳性,其中志贺菌属感染14例(53.8%),大肠埃希菌属感染5例(19.2%),沙门菌属感染3例(11.5%),肺炎克雷伯杆菌、嗜水气单胞菌、摩氏摩根菌、雷氏普罗威登斯菌感染各1例(3.8%)。年龄≤60岁患者病原菌的检出率高于年龄﹥60岁者(P﹤0.05)。志贺菌属感染以黏液便、水样便为主,大肠埃希菌与沙门菌感染以稀便为主。志贺菌、大肠埃希菌及沙门菌普遍对氨苄西林耐药,对β-内酰胺酶类、头孢菌素类和喹诺酮类等抗菌药物产生不同程度的耐药性;尚未发现病原菌对碳青霉烯类抗菌药物产生耐药性。结论肠道门诊细菌感染性腹泻患者粪便细菌培养阳性率较低,仍以志贺菌属为主要病原菌。监测病原菌分布、药敏结果,合理选择抗菌药物对降低细菌耐药十分重要。     

Bacterial enteropathogens isolated in childhood diarrhoea in Kuala Lumpur--the changing trend

A retrospective review of all stool samples obtained from children aged < 16 years with diarrhoea from University of Malaya Medical Centre (UMMC), Kuala Lumpur, from 1978 to 1997 was undertaken to ascertain the pattern of bacterial pathogens causing diarrhoea in children in an urban area in Malaysia. Of 26444 stool samples processed, 2989 (11%) were positive. The five most common bacterial pathogens isolated were non-typhoidal Salmonella (57%), enteropathogenic E. coli (EPEC) (14%), Shigella spp. (11%), Campylobacter spp. (5%) and Aeromonas spp. (4%). There was a significant reduction in the average percentage of positive isolation during the last 5 years of the study period as compared to the first 5 years (15.0% vs. 7.2%; r = -0.92, p = 0.0001). EPEC and Shigella spp. were less commonly isolated in the last five years compared with the first five years of the study (6% vs 21% p < 0.001 for E. coli; 7% vs 22%, p < 0.001 for Shigella spp.). This information is important for public health education in reducing the incidence of childhood diarrhoea further, and in the selection of appropriate antimicrobials in the management of extra-intestinal complications of childhood diarrhoea.     

儿童社区获得性腹泻病原菌菌谱及药敏分析

目的 了解儿童社区获得性腹泻病原菌分布及耐药情况.方法 本研究对598例在2008～2010年度本院门诊的急性腹泻患儿进行志贺菌、沙门菌、致泻性大肠埃希菌、变形杆菌、肠球菌、金黄色葡萄球菌培养分离、鉴定及药敏.结果 在分离的病原菌中,致泻性大肠埃希菌、肠球菌属和金黄色葡萄球菌为前三位的病原菌,分别占27.5％、26.9％和23.4％;金黄色葡萄球菌对万古霉素均敏感,对红霉素、青霉素的耐药率均＞50％;肠球菌对万古霉素敏感,环丙沙星、高浓度庆大霉素和红霉素均有较高的耐药率;大肠埃希菌对亚胺培南均敏感,而对哌拉西林、环丙沙星、庆大霉素耐药率较高;亚胺培南、头孢噻肟、氨曲南、阿米卡星、环丙沙星对志贺菌有较好的抗菌作用.结论 肠球菌是主要的儿童社区获得性腹泻的病原菌;细菌性腹泻在小儿社区获得性腹泻中占一定的比例,应重视病原菌的分离.     

Value of stool examination in patients with diarrhoea

Findings of stool examinations in 1593 patients with diarrhoea due to a single enteric pathogen--enterotoxigenic Escherichia coli rotavirus, Shigella, Campylobacter jejuni, Vibrio cholerae 0:1, Entamoeba histolytica, or Giardia lamblia--were reviewed to determine how well they predicted the agent associated with the diarrhoea. Specimens were examined visually for blood and mucus, tested for pH, and examined under a microscope for the presence of red and white blood cells, parasites, and stool fat. Although visible blood was more common in specimens from patients infected with Shigella (51%) and Ent histolytica (39%) than in those from patients infected with other agents (6%; p less than 0.01), patients infected with Shigella were most likely to have numerous faecal leucocytes (greater than 50/high power field: 39% v 8% of all patients and 7% of patients infected with Ent histolytica, p less than 0.01 in both cases). Patients infected with enterotoxigenic E coli, rotavirus, V cholerae 0:1, or C jejuni had loose stools with fewer red or white cells. Patients infected with rotavirus and C jejuni were more likely to have acid stools with 3 to 4+ fat, but these findings were related to young age and breast feeding. Stool examination is most useful in establishing a diagnosis of dysentery and in helping to distinguish between patients infected with Shigella and Ent histolytica; it is of limited usefulness in discriminating between pathogens causing watery diarrhoea.     

240例小儿细菌性腹泻病原学检测与临床用药效果研究

目的 :了解小儿细菌性腹泻的主要病原菌及不同药物的治疗效果,用以指导临床上合理用药.方法 :对2014年12月~2015年12月在我院儿科就医的细菌感染性腹泻的240例小儿大便标本进行病原学检验,并分别应用头孢曲松钠和氨苄青霉素对患儿分组进行治疗,观察疗效.结果 :①小儿细菌性腹泻好发于夏、秋季节,粪检病原菌阳性率37.50%,主要病原菌为志贺菌、大肠埃希菌和克雷伯菌,病原菌检出率在不同年龄组间差异有统计学意义;②应用头孢曲松钠治疗的总有效率为96.67%,优于氨苄青霉素(86.67%),两组疗效的比较差异有统计学意义,典型临床症状改善的时间均为头孢曲松钠组少于氨苄青霉素组.结论 :用药前进行细菌分离鉴定,有助于对症用药,应用头孢曲松钠治疗小儿细菌性腹泻疗效可观.     

闽东农村婴幼儿腹泻病原学调查

对闽东农村５８２例婴幼儿腹泻患者进行细菌性病原调查，在２０８例腹泻患儿粪便中检出致泻菌２４６株，检出率为４２．２６％，其中ＥＴＥＣ７７株（１３．２３％），ＥＩＥＣ１９株（３．２６％），空肠弯曲菌１７株（２．９２％），沙门氏茵６株（１．０３％），亲水性气单胞菌２株（０．３４％）。表明致泻大肠杆菌（ＥＴＥＣ，ＥＰＥＣ，ＥＩＥＣ）是我区婴幼儿致泻主导菌群，占检出菌的６６．３％。混合感染率在农村腹泻患儿中高达１７．３％，值得临床工作者重视。     

Escherichia coli O157:H7, an emerging gastrointestinal pathogen. Results of a one-year, prospective, population-based study

To examine the incidence of Escherichia coli O157:H7 enteric infections in the United States and to evaluate the vehicles of transmission for sporadic cases, we conducted a one-year, population-based study at a large health maintenance organization (HMO) in the Puget Sound area of Washington State. All stool specimens submitted for culture to the HMO laboratory were screened for E coli O157:H7; the organism was identified in 25 (0.4%) of 6485 stool specimens. All patients with E coli O157:H7 identified had diarrhea; 24 patients (96%) had bloody diarrhea. Exposure histories demonstrated that rare ground beef was consumed more often by patients (21%) than by age-matched control subjects (4%) in the week before onset of illness. Raw milk also was consumed by two patients but by none of the control subjects. Incidence rates for laboratory-confirmed enteric infections in the HMO population were as follows: Campylobacter, 50/100,000 person-years; Salmonella, 21/100,000 person-years; E coli O157:H7, 8/100,000 person-years; and Shigella, 7/100,000 person-years. The organism is a more common pathogen in the United States than is generally recognized, and the diagnosis should be considered for patients with suspected enteric infection.     

Yersinia enterocolitica infection in children

The role of Yersinia enterocolitica as a human pathogen has been documented in publications from over 30 countries, and Y. enterocolitica has been recognized increasingly to cause gastrointestinal disease in children. In 1979, an Australian survey yielded only three isolates of Y. enterocolitica from 3298 faecal specimens obtained from adults. We screened all stool specimens received during a 22-month period for Yersinia by means of a recently developed selective agar medium. Y. enterocolitica was isolated from 32 of 4136 (0.7%) specimens. Most isolates were of serotype O:3, biotype 4. During the study, 154 Salmonella spp. (3.7%), 196 Campylobacter spp. (47%), seven Shigella spp. (0.2%) and 27 Aeromonas spp. (0.9% of 2779) were recovered. Children infected with Y. enterocolitica presented with acute diarrhoea associated with fever and pharyngitis; chronic or recurrent diarrhoea; or pain in the right iliac fossa associated with mesenteric adenitis. Gastrointestinal symptoms usually resolved spontaneously within two weeks. However, some children were treated successfully with cotrimoxazole.     

Single-dose tetracycline therapy for shigellosis in adults.

Forty-two adults who had Shigella isolated from stool (26 symptomatic, 16 asymptomatic) received a single oral dose of tetracycline hydrochloride (2.5 g). Minimal inhibitory concentrations of the 42 isolates demonstrated that 41% were sensitive to tetracycline. Sixteen of 18 patients with diarrhea who had tetracycline-resistant Shigella and all eight patients with diarrhea who had tetracycline-sensitive Shigella were clinical well and had Shigella-negative stools 48 hours after therapy. Fifteen of 16 asymptomatic patients demonstrated clearing of Shigella from stool within 48 hours of therapy. Single-dose tetracycline therapy is effective in the treatment of Shigella regardless of clinical expression of illness or in vitro sensitive of the organism.     

武汉社区腹泻病人粪便中致病菌的构成与耐药性研究

目的了解夏秋季武汉社区引起腹泻病原菌的流行性及耐药状况。方法收集2004年7月1日至10月31日武汉社区4所大型医院4536份门诊腹泻病人粪便标本进行鉴定及药敏试验;REP-PCR对主要致病菌进行基因分型。结果4536份粪便标本中,分离出非伤寒沙门菌64株（1.4%）,志贺菌29株（0.6%）,致病性大肠杆菌33株（0.7%）。其中主要致病菌是鼠伤寒沙门菌33株（52%）,D群志贺菌16株（55%）。挑选13种抗菌药物进行体外敏感试验,并将分离的致病菌对这13种抗生素的耐药率﹑敏感率﹑中介率进行比较,其中非伤寒沙门菌对喹诺酮类的耐药率较其他两种要高,但对第三代头孢的敏感性较强。分离的3种致病菌在第三代头孢抗生素的作用中对头孢他啶的敏感性最强。32株鼠伤寒沙门菌基因分型为9种,16株D群志贺菌基因分型为7种。结论武汉社区内感染性腹泻的致病菌主要以非伤寒沙门菌﹑致病性大肠杆菌和志贺菌为主,其中非伤寒沙门菌占了51%,基因分型提示有社区流行趋势,而且这些致病菌对肠道杆菌常用抗生素的耐药性较为严重。本次调查结果对该社区临床用药起到一定的提示作用。     

Aetiology of diarrhoea in pre-term neonates at Kenyatta National Hospital nursery, Nairobi, Kenya

The aetiology of two outbreaks of diarrhoea in pre-term neonates (March-August; September, 1987), at Kenyatta National Hospital was studied. The first outbreak involved 98 neonates and enteropathogenic E. coli of different serotypes were the most commonly isolated agents (54%), with serotype 086a:K61 dominating. These were followed by Salmonella (16%) also of different groups, and then rotavirus (6%). Two campylobacter and two Shigella were isolated from four individual neonates. Mixed infections were mainly those of Salmonella and E. coli (5 cases). E. coli serotype 086 was found to be in circulation throughout the study period (March-August, 1987), whilst 044:0125 and 0128 circulated for a limited period. Salmonella and some strains of E. coli caused persistent diarrhoea despite antibiotic therapy. Nosocomial infections were found to play a role in subsequent diarrhoeas. In the second diarrhoea outbreak, again enteropathogenic E. coli and Salmonella were the most frequently isolated. However, in this outbreak, there was no single E. coli serotype revealed that some possessed plasmids of 120-160 megadalton. However, a search for human immunodeficiency viral antibodies in 120 stools produced negative results.     

Species distribution and antibiotic resistance of shigella isolates in an urban community in Malaysia

There is an increasing trend for Shigella isolates worldwide to be resistant to commonly prescribed antibiotics. The species distribution and antibiotic resistance of Shigella species isolated from children in Kuala Lumpur, Malaysia from 1978 to 1997 was reviewed. Three hundred and eighty six isolates were positive for Shigella species, representing 1.4% (95% CI: 1.3%-1.6%) of the 26320 total stool specimens and 13% (95% CI: 11.8%-14.2%) of 2986 isolates positive for bacterial pathogens. Shigella flexneri, constituting 74% of all isolates in the first five years of the study, decreased by 40% during the last five years (95% CI of decrease: 22.1%-57.9%), p-value < 0.0001) to 34%. There was a significant reduction (chi2 for linear trend = 77.6, p-value < 0.001) in the number of Shigella isolates as a percentage of total stool isolates obtained. 58% of the 241 isolates tested for antibiotic sensitivity were resistant to at least one antibiotic, and 42% wEre multi-resistant to three or more antibiotics. Shigella species was not a common pathogen among children admitted with diarrhoea in Kuala Lumpur, and was more likely to be resistant to commonly prescribed antibiotics.     

携带毒力岛大肠杆菌性小儿腹泻

目的：探讨携带毒力岛大肠杆菌（HPIEC）在小儿腹泻中的病原学地位。方法：采用PCR扩增和菌落原位杂交检测HPIEC－irp2毒力岛基因,并用血清学分型和聚合酶链反应（PCR）法检测各类致泻大肠杆菌。结果：从1032例腹泻患者粪便中分离出652株大肠杆菌,经血清学和PCR毒力基因分型,检出各类致泻大肠杆菌225株,其中肠致病性大肠杆菌（EPEC）20株,ETEC81株,产志贺样毒素大肠杆菌（SLTEC）47株,产志贺样毒素侵袭性大肠杆菌（ESIEC）74株,产毒素大肠杆菌（EIEC）3株。所有致泻大肠杆菌和未能分型的普通大肠杆菌株,再用HPIEC－irp2探针作菌落原位杂交,共检出携带毒力岛大肠杆菌（HPIEC－irp2)112株,总阳性率为17．2％。其中41例是从致泻大肠杆菌ESIEC（24／74）和SLTEC（17／47）中检出。携带毒力岛大肠杆菌性小儿腹泻的主要临床表现为食欲不振（87．5％）,腹痛（58．0％）,腹泻（＞6次／d,75．9）,发热（50．9％）,以粘液便为主（69．6％）。结论：携带毒力岛大肠杆菌是引起小儿腹泻的重要病原菌之一。     

合肥市新生儿感染性腹泻病原的调查

1988年3～5月对合肥市两所医院(甲、乙医院)婴儿室新生儿感染腹泻病原菌进行调查,336名新生儿中RV感染率14%,EPEC感染率2.1%,其余细菌未检出。乙医院感染率高于甲医院。发现同时感染RV和EPEC但不发病。提示新生儿可以携带RV和EPEC,其意义有待进一步研究。     

2010—2011年青海省传染病技术平台腹泻症候群监测结果分析

目的了解青海省腹泻症候群细菌性致泻性病原菌谱的分布特点及病原谱构成,为制定预防措施提供科学依据。方法收集2010年5月～2011年12月青海省2所哨点医院共304例腹泻患者的粪便标本,增菌培养后,可疑菌株用VITEKII全自动细菌鉴定仪和血清学诊断方法进行鉴定。结果304份粪便标本中共分离出52株菌株,分离率为17．11％,其中沙门菌15株、致泻性大肠埃希菌株6株、志贺菌25株、小肠结肠炎耶尔森菌2株、副溶血弧菌1株、嗜水气单胞菌1株、EHEC0157H72株;弯曲菌未检出。结论志贺氏菌、沙门氏菌为青海省细菌性腹泻病人的主要病原菌,婴幼儿是高发人群,加强监测和防治仍是今后的工作重点。     

Oral aztreonam, a poorly absorbed yet effective therapy for bacterial diarrhea in US travelers to Mexico.

OBJECTIVE--To evaluate a poorly absorbed antimicrobial with in vitro activity against all major bacterial enteropathogens in oral therapy for bacterial diarrhea. DESIGN--One hundred ninety-one US students with diarrhea acquired in Mexico received 100 mg of aztreonam or matching placebo three times a day for 5 days. Stools were cultured for bacterial enteropathogens before and after therapy. SETTING--We studied US students who acquired diarrhea in Mexico (travelers' diarrhea) in view of the high frequency of bacterial agents in this setting. MAIN OUTCOME MEASURE--We examined time of clinical recovery, treatment failures, adverse experiences, and microbiologic eradication from stool of the etiologic agent in subjects randomized to receive aztreonam or placebo. RESULTS--Aztreonam reduced the average duration of diarrhea compared with the placebo: for all cases, by 40 hours (P much less than .01); for those with enterotoxigenic Escherichia coli diarrhea, by 50 hours (P less than .01); for those with shigellosis, by 90 hours (P, not significant [small sample size]); for all bacterial agents, by 57 hours (P much less than .01). Clinical failures during the 5 days of therapy were seen in six patients (6%) receiving aztreonam and 25 (27%) receiving placebo (P less than .01). Pathogen eradication occurred in 95% of those receiving aztreonam and in 70% of those receiving the placebo (P less than .01). All bacterial enteropathogens were susceptible in vitro to aztreonam. The drug was well tolerated. CONCLUSIONS--Oral aztreonam, which is poorly absorbed, was well tolerated and was an effective therapy for bacterial diarrhea in US adults in Mexico.     

PCR检测与细菌培养方法在细菌性痢疾监测中的应用比较

目的 通过与PCR检测比较，确定细菌培养方法对细菌性痢疾疾病负担的低估程度。方法 从2002年细菌性痢疾监测研究获得的10105份腹泻标本中随机选取337份，采用针对ipaH基因的PCR方法检测其志贺菌感染，并同传统细菌培养方法进行比较。结果 337份腹泻标本中检测到ipaH基因212份，检出率为62．9％；而粪便培养阳性为39份，检出率为11．6％（P〈0．001）。Logistic回归分析显示影响PCR检出的因素依次为细菌培养结果（OR=15．5；95％CI：2．0-119．0），具有发热症状（OR=2．8；95％CI：1．2-6．2），菌痢流行季节的腹泻（OR=2．4；95％CI：1．4-4．3）及女性病例（OR=1．8；95％CI：1．1-3．0）。结论 与PCR检测相比，传统细菌培养方法使得菌痢的发病率在相当大的程度上被低估。     

2010—2011年深圳市龙岗区腹泻病原菌的流行特征

目的掌握本地区腹泻病的菌群分布和变化,为食源性疾病主动监测体系提供必要的监测数据。方法分析2010—2011年龙岗区2个腹泻病监测哨点患者的粪便标本,检测沙门菌（SM）、志贺菌（SH）、霍乱弧菌（VC）、副溶血弧菌（VP）和致泻性大肠埃希菌（DEC）等病原菌结果。结果3271份粪便标本中,检出病原菌共797株,阳性率为24．37％．腹泻病原菌占前3位的分别为DEC、VP和SM。025、01和0164是DEC主要流行血清型,vP优势血清型为03：K6和04：K8,SM的优势血清型为肠炎沙门菌和鼠伤寒沙门菌。VP和SM有明显季节性分布特点,主要在6-9月份阳性检出;沙门菌10岁以下儿童感染率高,vP和SM不同年龄组间差异有统计学意义（P=0．000;P=0．007）。结论本地区腹泻病原菌以DEC、VP和sM为主,肠炎沙门菌为sM最主要流行血清型,初步揭示了深圳市谚岗庆细菌件腹泻的病原谱及流行病学分布特征．     

Comparison of methods in the detection of enterotoxigenic Escherichia coli in a Malaysian laboratory

The prevalence of Enterotoxigenic Escherichia coli (ETEC) in 433 stool samples from diarrhoeal cases of all ages was studied using two commercially available test kits for the detection of heat labile toxin (LT) and the infant mouse assay for the heat stable toxin (ST). 16 samples (3.7%) were positive for ETEC, of which nine were producing ST alone, six LT alone and only one was producing both LT and ST. Although the percentage of isolation rate was low, its occurrence was almost as common as the Shigella spp and Salmonella spp in the same study. Of the two test kits examined, the Phadebact ETEC-LT Test 50 (Pharmacia Diagnostics, Uppsala, Sweden) was found to be more suitable for use in a routine diagnostic laboratory. Ten out of 12 (83%) of the strains tested were resistant to one or more antibiotics.     

3955例细菌性痢疾病例临床特征

目的了解细菌性痢疾病例的临床特征和大便常规检查情况,为提高临床诊断和鉴别诊断提供依据。方法2008年5月—2014年10月在位于天津市区、近郊地区、滨海新区和远郊地区的医疗机构设立监测点,将细菌性痢疾的成人和儿童病例作为研究对象,采用统一的流行病学调查表,经患者或儿童家长知情同意后,收集患者临床特征和大便常规结果。结果共收集细菌性痢疾病例流调表3 955份,其中检出志贺菌229份。195例5岁以上检出志贺菌的病例中,脓血便者占22.05%,里急后重者59.49%,体温≥39.0℃的为16.92%,检出志贺菌的病例中脓血便、里急后重和体温≥39.0℃的比例高于未检出的病例,差异均有统计学意义(P0.05)。34例5岁以下检出志贺菌的病例中,体温≥39.0℃的为32.35%,大便常规检测显示白细胞数≥15个/HPF者为88.24%,检出志贺菌的病例体温≥39.0℃和白细胞数≥15个/HPF者的比例高于未检出病例,差异有统计学意义(P0.05)。结论细菌性痢疾病例的临床特征已不明显,诊断标准中重要的临床症状、体征等诊断指标愈加少见。临床诊断需要充分考虑实验室发现,参考流行病学资料。