北京地区成人其他细菌性感染性腹泻临床特点调查研究

目的探讨北京地区成人其他细菌性感染性腹泻的临床特点、流行病学、病原菌分布及耐药性,为疾病诊治及肠道传染病防控提供依据。方法回顾性收集2016年1月1日至2018年10月31日首都医科大学附属北京潞河医院感染性疾病科肠道门诊确诊的264例其他细菌性感染性腹泻患者的临床资料,对患者年龄、发病时间、临床特点、粪便标本细菌培养及药敏试验结果进行分析。结果本组患者中位年龄为42岁,男性占47.0%,临床症状以腹痛、腹泻、呕吐、发热为主,其中193例(73.1%)患者可追问到可疑不洁饮食史。264例患者粪便标本均分离出病原菌,共282株,其中以致病性大肠埃希菌最为常见(127株,45.0%),其次为副溶血弧菌(79株,28.0%)和沙门菌(48株,17.0%)。共有9例(3.41%)患者为混和菌感染,致病菌检出高峰为6~10月,集中在夏秋季。不同病原菌有不同的耐药谱,但其对亚胺培南敏感率均达100%;3种主要病原菌对抗生素药物均有多重耐药状况,其中致病性大肠埃希菌对氨苄西林、红霉素、头孢唑林、复方磺胺甲恶唑及四环素类明显耐药,但对头孢他啶、头孢西丁、氯霉素及头孢噻肟等较敏感;副溶血性弧菌对红霉素、萘啶酸、头孢唑林、阿奇霉素耐药,但对其他抗生素均较敏感;沙门菌对红霉素、萘啶酸、环丙沙星耐药,但对头孢西丁、氯霉素、复方磺胺甲恶唑、阿奇霉素较敏感。结论其他细菌性感染性腹泻好发于夏秋季,多与不洁饮食有关,病原菌以致病性大肠埃希菌、副溶血弧菌、沙门菌多见,临床医生应加强对其他细菌性感染性腹泻的认识,提高诊治率,并根据药敏试验结果合理选择抗生素治疗。

Clinical characteristics of other bacterial infectious diarrhea in adults in Beijing

Objective Objective:To explore the clinical characteristics,epidemiology,pathogenic bacteria distribution and drug resistance of other bacterial infectious diarrhea in adults,and to provide evidence for disease diagnosis,treatment and prevention and control of intestinal infectious diseases.Methods The clinical data of 264 patients with other bacterial infectious diarrhea diagnosed in our intestinal clinic from January 1,2016 to October 31,2018 were retrospectively collected.The age,onset time,clinical characteristics,bacterial culture of stool specimens and drug sensitivity test results were analyzed.Results The median age of this group was 42 years old,and 47.0%of the patients were male.The main clinical symptoms were abdominal pain,diarrhea,vomiting and fever.193 patients(73.1%)could inquire about suspicious unclean diet history.A total of 282 pathogenic bacteria were isolated from 264 stool specimens,among which pathogenic Escherichia coli was the most common(45.0%),followed by Vibrio parahaemolyticus(28.0%)and Salmonella(17.0%).A total of 9 patients(3.41%)were infected with mixed bacteria.The detection peak of pathogenic bacteria was from June to October,mainly in summer and autumn.Different pathogenic bacteria have different drug resistance spectrum,but their susceptibility to imipenem is 100%.Three main pathogenic bacteria have multiple drug resistance to antibiotics.Among them,diarrhea-causing Escherichia coli is obviously resistant to ampicillin,erythromycin,cefazolin and compound sulfonamide and tetracycline,but more sensitive to ceftazidime,cefoxitin,chloramphenicol and cefotaxime;Vibrio parahaemolyticus is resistant to erythromycin,nalidionic acid,cefazolin,azithromycin;Salmonella is resistant to erythromycin,naphthoic acid and ciprofloxacin,but sensitive to cefoxitin,chloramphenicol,cotrimoxazole,azithromycin.Conclusion Other bacterial infectious diarrhea often occurs in summer and autumn,mostly related to unclean diet,pathogenic bacteria so that pathogenic Escherichia coli,Vibrio parahaemolyticus and Salmonella are more common.Clinicians should strengthen the understanding of other bacterial infectious diarrhea,improve the diagnosis and treatment rate,and rationally select antibiotics based on drug sensitivity test results.