临床分离志贺菌的血清分型及耐药性分析

目的了解3年来梅拢地区志贺菌的血清型和耐药性的变化. 方法收集临床分离的志贺菌进行生化鉴定、血清学分型,并对部分菌株进行抗生素敏感试验.结果志贺菌中福氏志贺菌占63.6%～69.6%,宋内志贺菌占30.4%～33.1%.志贺菌对常见药物的耐药性逐年增加.福氏志贺菌对抗菌素的敏感率依次为第三代头孢菌素95%、哌拉西林17%、氟喹诺酮类22%.宋内志贺菌对氟喹诺酮类最敏感,约为90%,对第三代头孢菌素的敏感率由2002年的100%下降至2004年的78%.结论 3年来梅拢地区志贺菌感染以福氏志贺菌和宋内志贺菌为主,福氏志贺菌以Ⅰ型、Ⅱ型和Ⅳ型为主,血清型逐年增多.志贺菌对常见抗生素的耐药性有增高趋势,必须作好药敏试验,指导临床合理用药.     

2007-2011年浙江省余姚市感染性腹泻志贺菌监测结果分析

目的 了解浙江省余姚市感染性腹泻患者中志贺菌感染状况。 方法 采集感染性腹泻患者的粪便或肛拭标本,进行增菌、分离、生化鉴定、血清分型、药敏试验和PCR毒力基因检测。 结果 2007-2011年共检验标本1360份,检出志贺菌36株,检出率为2.65%,其中福氏2a志贺菌4株,占11.11%;福氏2b志贺菌3株,占8.33%;福氏1d志贺菌11株,占30.56%;福氏Xv志贺菌12株,占33.33%;宋内志贺菌6株,占16.67%;检出的志贺菌对多种抗生素耐药。 结论 2007-2011年引起余姚市细菌性痢疾主要病原菌是福氏志贺菌,其次为宋内志贺菌;福氏志贺菌有多种血清型,其中Xv血清型分离率最高;药敏试验以氨基糖苷类、喹诺酮类及部分头孢类抗生素敏感性较好;毒力基因呈现多样性。     

132株志贺菌耐药性分析

目的了解志贺菌的耐药特征,为预防和治疗提供指导性依据。方法对132株志贺菌进行血清学分型及K-B琼脂法药敏试验。结果在132株志贺菌中,共检测到分A、B、D三群,其中A群(志贺菌)占5.30%,B群(福氏菌)占68.94%;D群(宋内菌)占25.76%,无C群(鲍氏菌)。药敏结果显示,志贺菌对氨苄西林和复方新诺明的耐药率高达94%以上,对庆大霉素、阿莫西林的耐药率也在40%以上;对头孢吡肟、头孢噻肟、环丙沙星、诺氟沙星和左氧氟沙星较为敏感。在不同的菌群间,福氏菌和宋内菌对环丙沙星、诺氟沙星、左氧氟沙星、头孢吡肟、头孢噻肟的耐药率差别无显著性(P>0.05),而对氨苄西林、阿莫西林、复方新诺明、庆大霉素的耐药率差异有显著性(P<0.05)。结论在临床用药上宜选第三代喹诺酮类药物及第三代头孢菌素类为首选药物。     

2011年夏季某院分离志贺菌特点及某地区志贺菌血清型流行趋势分析

目的 了解该院2011年分离的志贺菌及相关病例特点,结合其他区县志贺菌分离情况,总结北京市志贺菌血清型转变特点.方法 Vitek Ⅱ Compact鉴定志贺菌,血清玻片凝集法鉴定血清型,药敏试验采用K-B法.结果 共分离获得志贺菌15株,其中宋内Ⅰ型14株,福氏F2a型1株;15株菌对复方新诺明、哌拉西林、氨苄西林均耐药,14株宋内Ⅰ型菌对环丙沙星、左氧氟沙星、阿米卡星、头孢他啶、头孢西丁、亚胺培南、头孢吡肟、氨曲南、哌拉西林/他唑巴坦均敏感.结论 宋内Ⅰ型志贺菌为主要分离菌,对环丙沙星、左氧氟沙星、阿米卡星、头孢他啶、头孢西丁、亚胺培南、头孢吡肟、氨曲南、哌拉西林/他唑巴坦保持高度敏感;宋内志贺菌已成为北京市流行志贺菌的主要血清型.     

福氏和宋内志贺菌的药物敏感度测定

目的了解本地区福氏志贺菌和宋内志贺菌对临床常用抗菌药物的耐药性。方法琼脂稀释法测定2004年5-10月我院肠道门诊分离的31株福氏志贺菌和37株宋内志贺菌对多种抗菌药物的敏感性。结果福氏志贺菌和宋内志贺菌对四环素、复方磺胺甲嗯唑、氨苄西林和氨苄西林-舒巴坦耐药显著，耐药率分别为100％～97．3％、90．3％～94．6％、90．3％～64．9％和67．7％～51．4％；2种细菌对氯霉素和庆大霉素的耐药性差异有显著性；2种细菌对氟喹诺酮类、第三代头孢菌素非常敏感，耐药率为6．5％～0％。结论本地区福氏志贺菌和宋内志贺菌对氟喹诺酮类和第三代头孢菌素非常敏感，对复方磺胺甲喙唑、氨苄西林、四环素等其他多种抗菌药物耐药显著，应加强耐药性监测和防治。     

浙江省温州地区志贺菌流行菌株的血清分型及耐药性分析

目的调查志贺菌在浙江省温州地区流行的主要血清型和耐药性。方法收集临床分离的志贺菌株进行生化鉴定、血清学分型和抗生素敏感性试验。结果116株志贺菌中28 株为宋内志贺菌,占24.1%;80 株为福氏志贺菌,占68.9%(包括4 株福氏变异株,占总数的3.5%),痢疾志贺菌7株占6.0%,鲍氏志贺菌1株占0.9%。宋内志贺菌对抗菌药物的敏感率依次为氟喹诺酮类（萘啶酸为14.4%）100%、第三、四代头孢为92.9%,对复方新诺明、萘啶酸、氨苄西林呈高耐药性。福氏志贺菌对诺氟沙星、环丙沙星、莫西沙星、洛美沙星、左氟沙星的敏感率为80%左右;对三、四代头孢的敏感率为97%,但头孢噻肟的敏感率仅为22.3%。鲍氏志贺菌出现严重耐药,只有亚胺培南和美洛匹宁敏感,其他均耐药。结论温州地区志贺菌感染以福氏志贺菌和宋内志贺菌为主,福氏志贺菌中以福氏4c型为主, 其次为血清2a 型和2b型。福氏志贺菌对各种抗生素耐药性有增高趋势;并出现严重耐药菌株,必须引起临床重视。     

太原市2006年分离志贺菌菌株的血清分型及耐药性分析

目的 调查太原市分离的志贺菌菌株的主要血清型和对常用抗菌药物的耐药性.方法 对从腹泻患者分离的志贺菌菌株进行血清分型、生化鉴定和药物敏感试验.结果 129份腹泻样本分离出阳性菌株40株,其中福氏志贺菌33株,占分离菌株的82.5%,宋内志贺菌7株,占分离总数的17.5%;福氏志贺菌中,4c 型21株,占63.6%.福氏志贺菌对萘啶酸100%耐药,对氨苄西林、四环素耐药性均为97%,对头孢噻肟、庆大霉素的药物敏感性均为97%.宋内志贺菌对萘啶酸、四环素、复方新诺明均100%耐药;对阿莫西林、头孢噻肟、环丙沙星的敏感性均为100%.结论 2006年太原市志贺菌优势菌型为福氏志贺菌4c型,志贺菌不同血清型对几种常用抗菌药物出现不同程度的耐药性.     

2006-2011年杭州市萧山区腹泻儿童分离志贺菌血清型分布及耐药性变迁

目的 调查志贺菌在杭州市萧山区儿童腹泻患者中流行的主要血清型分布和耐药变迁,为临床治疗和预防提供参考依据。 方法 对2006年1月至2011年12月浙江萧山医院临床分离自腹泻儿童志贺菌菌株,进行生化鉴定、血清学分型和抗生素敏感性试验,所有数据用WHONET 5.6软件进行回顾性分析。 结果 318株志贺菌中221株(69.5%)为宋内志贺菌, 96株(30.2%)为福氏志贺菌, 鲍氏志贺菌1株(0.3%);200株(62.9%)分离自年龄组为5岁的婴幼儿;志贺菌对氨苄西林的耐药率最高达97.1%,对复方新诺明耐药率达88.8%,头孢噻肟耐药率为44.7%,未检出头孢哌酮/舒巴坦、亚胺培南和美罗培南耐药株,福氏志贺菌对环丙沙星和左旋氧氟沙星耐药率为44.8%和33.3%,而宋内志贺菌未检出氟喹诺酮类耐药株;福氏志贺菌和宋内志贺菌耐药率在哌拉西林、头孢他啶、头孢吡肟、复方新诺明和氟喹诺酮间差异有统计学意义(P0.01)。 结论 杭州市萧山区腹泻儿童志贺菌感染以宋内志贺菌为主,青霉素类和复方新诺明耐药率很高已不适合临床使用,含酶抑制剂抗生素是治疗志贺菌感染的首选药物,哌拉西林、头孢噻肟、环丙沙星和左旋氧氟沙星表现出耐药率上升趋势。     

志贺菌的菌型分布与耐药性分析

目的了解上海地区近年来志贺菌的菌型分布与耐药现状，指导临床合理用药。方法对临床分离的120株志贺菌进行生化鉴定、血清学分型和Kirby-Bauer纸片扩散法（K-B法）药物敏感性试验。结果120株志贺菌中，福氏志贺菌62株占51．7％（包括福氏变异株7株，占总数的5．8％），宋内志贺菌58株占48．3％。志贺菌对多种常用抗菌药物呈高度耐药，且多为多重耐药，对第三代头孢菌素的耐药率最低，其次为氟喹诺酮类。福氏志贺菌与宋内志贺菌对多种药物的耐药率差异有显著性。结论上海地区检出的志贺菌以福氏和宋内志贺菌为主，福氏志贺菌中以福氏2型居多（占67.7％），其次为福氏1型（占14．5％）；志贺菌尤其是福氏志贺菌对某些抗生素的耐药率有上升趋势，应引起临床重视，根据药敏试验结果合理用药。     

194株志贺菌的流行病学分析及药物敏感调查

目的　了解闵行区引发痢疾的志贺菌优势菌型及其药物敏感状况 ,为痢疾临床治疗和预防控制提供依据。方法　采用血清凝集试验、菌种ATB鉴定仪系统生化鉴定和K -B法对从腹泻病人分离的志贺菌进行流行病学分析和药物敏感试验。结果　 194株志贺菌中福氏志贺菌 16 1株 ,宋内志贺菌 33株。共分为 8个血清型 ,其中福氏 1a 4 6株 ,福氏 2b 4 2株 ,福氏 2a 19株 ,福氏x变种 19株 ,福氏 4c 30株 ,还有福氏 4a、福氏 5a、福氏 5b共 5株。复方新诺明耐药率 89 .6 9%、氨苄西林耐药率 88 .14 %、氯霉素耐药率 6 0 . 31% ,头孢噻肟、丁胺卡那、头孢噻吩、头孢唑啉、庆大霉素、氟哌酸均敏感 ,耐药率均在 10 %以下。结论　本地区志贺菌感染的优势菌型为福氏 1a型和福氏2b型 ,而新型的志贺菌福氏 4c型和宋内志贺菌今后应引起足够重视。药物头孢噻肟、丁胺卡那霉素、头孢噻吩、头孢唑啉可作为目前临床治疗痢疾的常用药物。     

Occurrence of integrons and resistance genes among sulphonamide-resistant Shigella spp. from Brazil

OBJECTIVES: To determine the occurrence of class 1 and 2 integrons and antimicrobial resistance genes among sulphonamide-resistant Shigella strains isolated in Brazil during 1999-2003. METHODS: Sixty-two Shigella (Shigella flexneri, n = 47 and Shigella sonnei, n = 15) were tested against 21 antimicrobial agents. The presence of integrons classes 1 and 2 and antimicrobial resistance genes was investigated by PCR using specific primers. RESULTS: A total of eight antimicrobial resistance profiles were identified, with the profile of resistance to sulfamethoxazole, trimethoprim, spectinomycin, streptomycin and tetracycline being the most common among S. sonnei, and additionally to ampicillin and chloramphenicol among S. flexneri. Class 1 integrons were found in only two strains, whereas class 2 integrons were found in 56 (90.3%) of the strains. All class 2-positive strains had a similar fragment of 2214 bp harbouring a gene cassette array conferring resistance to trimethoprim, streptothricin and spectinomycin/streptomycin. The genes coding for resistance to chloramphenicol (catA1), tetracycline [tet(A) and tet(B)] and ampicillin (bla(OXA) and bla(TEM)), were detected in resistant strains. CONCLUSIONS: The detection of class 1 and 2 integrons and additional antimicrobial resistance genes allowed us to identify the most frequent antimicrobial resistance patterns of Shigella spp. isolated in Brazil.     

上海地区小儿细菌性痢疾菌型与抗菌药物敏感性研究

目的：检测本地区小儿细菌性痢疾的菌株及其对常用抗生素的敏感性，以便为临床用药提供有效的指导。方法：收集2000年1月～2002年12月到上海儿童医学中心就诊的急性腹泻患儿新鲜粪便标本1935份，应用Kirby Bauer纸片扩散法进行药敏检测。结果：1935份标本共检出志贺菌182株，其中福志贺菌113株，宋内志贺菌69株，未检到其他血清型。182株志贺菌中有70．9％(129／182)的菌株对氨苄西林耐药，154株(84．6％)对复方新诺明耐药；94％以上的菌株对诺氟沙星(NFX)、环丙沙星(CIP)、头孢噻肟(CTX)、庆大霉素(GEM)敏感。结论：上海地区志贺菌血清型以福志贺菌为主，宋内志贺菌有逐年增多趋势。94％以上志贺菌对CIP、CTX、NFX、GEM敏感，尤其前三者可作为临床首选药物治疗细菌性痢疾。     

Increasing antimicrobial resistance of Shigella isolates in Israel during the period 1984 to 1992.

Recent (1984 to 1992) trends in the antimicrobial resistance of Shigella isolates in Israel were studied by analyzing the results of 106,000 stool cultures, 3,511 of which yielded Shigella spp. Over the study period, resistance to trimethoprim-sulfamethoxazole (TMP-SMX) increased from 59 to 92% (P = 0.0038) and that to ampicillin increased from 13 to 86% (P < 0.0001). Resistances to nalidixic acid, chloramphenicol, and broad-spectrum cephalosporins remained low. Shigella sonnei, which currently accounts for 90% of Shigella infections, was more resistant than S. flexneri to TMP-SMX (81 versus 57%, P < 10(-6)), ampicillin (42 versus 32%, P < 10(-5)), and tetracycline (38 versus 28%, P < 10(-5)). S. boydii and S. dysenteriae were relatively rare. Seasonality in antimicrobial resistance was found, with summer isolates being less resistant to TMP-SMX, ampicillin, or both than isolates obtained over the rest of the year (P < 10(-5)). We conclude that the resistance of shigellae, especially S. sonnei, to TMP-SMX and ampicillin is increasing to approximately 90%. Resistance should be recorded locally, and empiric therapy for suspected shigellosis should be changed accordingly.     

Acute bacterial diarrhoea in the emergency room: therapeutic implications of stool culture results.

Empiric treatment with ciprofloxacin and norfloxacin has been recommended recently for patients with acute diarrhoeal disease. In a retrospective 6-month study period the results of stool cultures from 209 patients with acute diarrhoea admitted to the emergency room were analysed. Seventy-eight cultures (37%) were positive for one or more bacteria. Shigella was the most commonly isolated pathogen (68%). Shigella sonnei comprised 72% and Shigella flexneri 19% of all the bacterial isolates. While no antimicrobial resistance to ciprofloxacin was found for both Shigella species, only 36 and 26% of the Shigella isolates were sensitive to ampicillin and trimethoprim-sulfamethoxazole (TMP-SMZ), respectively. These findings point out to the emergence of drug resistance to commonly used antimicrobial drugs. Shigella's high sensitivity to the newer quinolones should make this the treatment of choice for the very sick patient, although physicians should be cautioned to the fact that indiscriminate use of this drug could result in the emergence of resistance similar to that noted with ampicillin and TMP-SMZ.     

Antimicrobial resistance of Shigella isolates causing traveler's diarrhea.

Shigella isolates were identified as a cause of traveler's diarrhea in 67 (10%) of 675 patients and were tested for resistance to seven antimicrobial agents in a comparative study with those causing nontraveler's diarrhea in Spain. Ampicillin and chloramphenicol resistance was more frequent in Shigella flexneri (60 and 46%, respectively) than in Shigella sonnei (32 and 18%, respectively) and in travel-related isolates (P < 0.05 and 0.04, respectively). Of S. sonnei isolates from patients with traveler's diarrhea, 73 and 54% showed tetracycline and trimethoprim-sulfamethoxazole resistance, respectively, compared with only 8% of isolates from patients without a history of travel to developing countries (P < 0.007 and P < 0.0002). Low-level resistance to cephalosporins was found, whereas quinolone-resistant strains were not detected among travel-related Shigella isolates. Thus, quinolones may be an effective alternative therapy for travel-related shigellosis.     

Decreased susceptibility to ciprofloxacin among Shigella isolates in the United States, 2006 to 2009

We characterized 20 Shigella isolates with decreased susceptibility to fluoroquinolones. Most patients (80%) from whom a travel history was obtained reported travel to South or Southeast Asia. Mutations within the quinolone resistance determining regions of gyrA and parC and plasmid-mediated resistance determinants (qnrB, qnrS, and aac(6')-Ib-cr) were identified. The rise in antimicrobial resistance among Shigella isolates may necessitate the increased use of extended-spectrum cephalosporins or macrolides in some patients.     

High prevalence of antimicrobial resistance among Shigella isolates in the United States tested by the National Antimicrobial Resistance Monitoring System from 1999 to 2002

Shigella spp. infect approximately 450,000 persons annually in the United States, resulting in over 6,000 hospitalizations. Since 1999, the National Antimicrobial Resistance Monitoring System (NARMS) for Enteric Bacteria has tested every 10th Shigella isolate from 16 state or local public health laboratories for susceptibility to 15 antimicrobial agents. From 1999 to 2002, NARMS tested 1,604 isolates. Among 1,598 isolates identified to species level, 1,278 (80%) were Shigella sonnei, 295 (18%) were Shigella flexneri, 18 (1%) were Shigella boydii, and 7 (0.4%) were Shigella dysenteriae. Overall, 1,251 (78%) were resistant to ampicillin and 744 (46%) were resistant to trimethoprim-sulfamethoxazole (TMP-SMX). Prevalence of TMP-SMX- or ampicillin- and TMP-SMX-resistant Shigella sonnei isolates varied by geographic region, with lower rates in the South and Midwest regions (TMP-SMX resistance, 27% and 30%, respectively; ampicillin and TMP-SMX resistance, 25% and 22%, respectively) and higher rates in the East and West regions (TMP-SMX resistance, 66% and 80%, respectively; ampicillin and TMP-SMX resistance, 54% and 65%, respectively). Nineteen isolates (1%) were resistant to nalidixic acid (1% of S. sonnei and 2% of S. flexneri isolates); 12 (63%) of these isolates had decreased susceptibility to ciprofloxacin. One S. flexneri isolate was resistant to ciprofloxacin. All isolates were susceptible to ceftriaxone. Since 1986, resistance to ampicillin and TMP-SMX has dramatically increased. Shigella isolates in the United States remain susceptible to ciprofloxacin and ceftriaxone.     

Genotypes and antimicrobial profiles of Shigella sonnei isolates from diarrheal patients circulating in Beijing between 2002 and 2007

Shigella sonnei has become the dominant serotype causing shigellosis in Asian countries in recent years. In this study, we characterize the increasing trend of antibiotic resistance profiles and genotypes of S. sonnei isolates in the Beijing area. From January 2002 to December 2007, a total of 1108 Shigella isolates including 362 S. sonnei were recovered from diarrhea patients at the 302nd Hospital in Beijing. While the frequency of S. flexneri gradually decreased, S. sonnei gradually increased and became the dominant species. A total of 362 S. sonnei isolates were further analyzed for their antimicrobial profiles and 272 revived isolates were selected for genotyping analysis, respectively. High-level antimicrobial resistances were observed in sulfamethoxazole/trimethoprim (94.5%), ampicillin (40.3%), piperacillin (36.5%), and ceftriaxone (12.8%) with significant single- and multiple-drug resistance increase trends from 2002 to 2007 (P = 0.0000). Pulsed-field gel electrophoresis analysis indicated that 263 (96.7%) S. sonnei belonged to 1 clonal genotype A, which were further divided into A1-A6 subtypes. While subtype A2 was dominant in the early stage of study years, subtype A4 started to emerge and increased significantly in later years. Antimicrobial resistance rates are statistically different among the 6 subtypes (P = 0.0000), and A4 possessed the highest resistance rates to ampicillin (83.7%) and piperacillin (81.4%). Subtype A3 was highly clustered in inpatients compared to other subtypes (P = 0.0145). This study indicates that a clonal S. sonnei strain has become dominant in the Beijing area, and subtype A4 is responsible for increased antibiotic resistance.     

Antimicrobial Resistance in Shigella flexneri and Shigella sonnei in Hong Kong, 1986 to 1995

Three hundred and thirty-three Shigella isolates obtained in 1986 to 1995 were tested for their susceptibilities to 19 antimicrobial agents. Nalidixic acid resistance had emerged in 59.6% of Shigella flexneri isolates during 1994 to 1995, with all tested resistant isolates having the mutation in gyrA encoding the Ser-83 alteration. Multiresistance (resistance to four or more agents) was more common in S. flexneri than in Shigella sonnei.     

Comparative in vitro activities of ten antimicrobial agents against bacterial enteropathogens.

The in vitro susceptibilities of 50 strains of Salmonella spp., 80 strains of Shigella spp., and 50 enterotoxigenic Escherichia coli, 14 Yersinia enterocolitica, 6 Aeromonas hydrophila, 4 Plesiomonas shigelloides, 9 Vibrio parahaemolyticus, and 30 Campylobacter jejuni strains that were recently isolated from worldwide sources were determined for 10 antimicrobial agents. The antimicrobial agents tested included ampicillin, bicozamycin, doxycycline, enoxacin (CI-919), erythromycin, furazolidone, amdinocillin, norfloxacin, trimethoprim, and trimethoprim-sulfamethoxazole. Ampicillin resistance occurred frequently in strains of Salmonella and Shigella spp. and enterotoxigenic E. coli strains. The most active agents against all of the bacteria tested were enoxacin and norfloxacin. Furazolidone and amdinocillin were also highly active against the majority of strains. Trimethoprim and trimethoprim-sulfamethoxazole were inhibitory at low concentrations against all test except C. jejuni isolates. The in vitro results of this study confirm the high prevalence of bacterial resistance to ampicillin. However, this work also identifies four antimicrobial agents, enoxacin, furazolidone, norfloxacin, and amdinocillin, that would be appropriate for further testing in clinical trials.