深圳市腹泻患者沙门菌感染状况和耐药性分析

目的 分析2014-2017年深圳地区腹泻患者沙门菌的感染特征和耐药性情况,为沙门菌感染的防控提供科学依据。方法 从深圳市3家哨点医院腹泻门诊收集患者粪便标本,进行沙门菌的分离鉴定、血清分型及药敏试验;对7家医院上送的住院病人分离的沙门菌进行血清分型和药敏试验。结果 4 847份门诊患者的粪便标本中,分离出192株沙门菌,检出率为4.0%。5-10月是沙门菌检出的高峰, 5岁以下儿童和6-17岁是感染的主要人群,检出率分别为6.2%和5.3%。192株沙门菌中鉴定出18种血清型,其中鼠伤寒沙门氏菌、鼠伤寒沙门氏菌变种和肠炎沙门氏菌是最常见的3种血清型,另有19株未能分型。77株住院病人分离的沙门菌中鉴定出20种血清型,其中肠炎沙门氏菌、鼠伤寒沙门氏菌变种、甲型副伤寒沙门氏菌占比分别为33.8%、13.0%和11.7%,另有3株未能分型。45株沙门菌对氨苄西林、环丙沙星和左旋氧氟沙星的耐药最为严重,自2015年开始出现对喹诺酮类药物的耐药和多重耐药菌株,10株鼠伤寒沙门氏菌中多重耐药率为50.0%。结论 深圳市腹泻患者的沙门菌感染以17岁以下儿童为主,5-10月份为感染的高峰期,沙门菌的血清型分散,其中肠炎沙门氏菌和鼠伤寒沙门氏菌、鼠伤寒沙门氏菌变种是主要的血清型,多重耐药自2015年开始日趋严重,临床上应合理规范用药并且加强耐药监测。

Prevalence and drug resistance of Salmonella isolated from diarrhea patients in Shenzhen,China

We analyzed the prevalence of Salmonella infection and drug resistance of Salmonella strains isolated from diarrheal patients in Shenzhen during 2014 and 2017. The stool samples were collected from patients visiting diarrhea clinics of 3 sentinel hospitals and Salmonella was isolated and identified. The serotype and antibiotic susceptibility testing were performed in these isolates, and also the isolates from inpatients in 7 hospitals. A total of 192 (4.0%) Salmonella isolates were recovered from 4 847 stool samples and the high detection rate was found during May and October. The higher detection rate was observed in the children aged under 5 years old and the age group of 6-17 years, with 6.2% and 5.3%, respectively. Eighteen serotypes were identified in the 192 isolates, with S. typhimurium, 1,4,12:i:- and S. enterica being the most commonly identified serovars. Another 19 strains were nontypeable. In comparison, 20 serotypes were identified in the 77 isolates from inpatients and 3 strains were nontypeable. S. enterica, 1,4,12:i:-, and S. paratyphi A made up 33.8%, 13.0%, and 11.7% of these isolates, respectively. Of the 45 tested strains, the drug resistance to ampicillin, ciprofloxacin, and levofloxacin was more serious than to other drugs. The quinolone-resistant and multi-drug-resistant (MDR) strains have occurred since 2015 and 50.0% of the 10 S. typhimurium isolates was MDR strain. These results indicated that reasonable the using of antibiotics for treatment of diarrhea and long-term surveillance of antibiotic resistance was required.