2016—2018年广州地区儿童非伤寒沙门菌感染的临床流行病学特征

目的 了解广州地区儿童非伤寒沙门菌感染的流行病学特征及临床特点，为本地区非伤寒沙门菌感染的预防和治疗提供借鉴。方法以2016年1月至2018年12月广州市第一人民医院及南沙中心医院分院腹泻患儿为研究对象，纳入研究的患儿均留取粪便进行细菌培养，记录就诊患儿的流行病学资料、人口学信息以及大便培养结果，对收集资料进行统计分析。结果2016—2018年共纳入2 658例，收集其大便标本进行大便细菌培养，共有258例粪便细菌培养沙门菌阳性，分离率为9.7%（258/2 658）；其中，4例为伤寒沙门菌，伤寒沙门菌分离率为0.2%（4/2 658）；非伤寒沙门菌254例，分离率为9.5%（254/2 658）。2016—2018年男女患病数为：男1 466例，女1 192例，男性大便分离阳性率为10.2%，女性大便分离阳性率为9.1%，两者差异无统计学意义（2=1.083，P=0.298）。2016—2018年各年龄组患儿沙门菌阳性率为2.5%～14.7%，以1～2岁年龄段阳性率最高，各年龄组间差异有统计学意义（2=7.52，P=0.000）。沙门菌阳性患儿不同年龄组的占比如下：<1岁为42.2%（109/258）；1～2岁为36.4%（94/258）；2～3岁为10.9%（28/258）；3～4岁5.0%（13/258）；4～5岁为0.8%（2/258）；5～10岁为3.1%（8/258）；10～18岁为1.6%（4/258）；其中，3岁以下患儿占比达89.5%。2016—2018年，各月份沙门菌分离阳性率在0.79%～14.45%之间，组间差异有统计学意义（F=5.719，P=0.000）。其中，1、2、3、12月分离阳性率较低（0.79%～2.1%），4~11月份分离阳性率（9.51%～14.45%）明显高于其他月份，且差异有统计学意义（P<0.01）。结论2016—2018年沙门菌感染性腹泻患儿中，以非伤寒沙门菌感染为主，伤寒沙门菌感染以散发出现。非伤寒沙门菌感染全年均可发病，高发季节为春夏秋三季，好发于3岁以下婴幼儿。

linical epidemiological characteristics of non-typhoid salmonella infection in children in Guangzhou from 2016 to 2018

Objective To investigate the epidemiological characteristics of Nontyphoidal Salmonella (NTS) infection in Guangzhou, and to provide reference for the prevention and anti-infection treatment of Salmonella infection in this region. Methods Children with diarrhea in the hospitals of Guangzhou first people′s hospital and Nansha central hospital from January 2016 to December 2018 were selected as the study objects. Feces samples of all the children included in the study were kept for bacterial culture. And the epidemiological data, demographic information and stool culture results of the children were recorded for analysis. Results A total of 2,658 fecal specimens were collected from 2016 to 2018 for fecal bacterial culture, and 258 fecal bacterial cultures were positive for salmonella, with a separation rate of 9.7% (258/2 658). Among them, 4 cases were salmonella typhi, with the isolation rate of 0.2% (4/2 658); and 254 cases were non-typhoid salmonella, with the separation rate of 9.5% (254/2 658). From 2016 to 2018, the number of male and female patients was 1,466 and 1,192, respectively. The positive rate of male fecal separation was 10.2%, and of female fecal separation was 9.1%. There was no statistically significant difference between the two groups (2=1.083, P=0.298). From 2016 to 2018, the positive rate of salmonella was 2.5%-14.7% in all age groups, with the highest positive rate in the age group 1-2 years old, and the differences among all age groups were statistically significant (2=7.52, P=0.000). The proportion of salmonella infection in different age groups was as follows, 42.2% (109/258) for <1 year old; 36.4% (94/258) for 1-2 years old; 10.9% (28/258) for 2-3 years old; 5.0% (13/258) for 3-4 years old; 0.8% (2/258) for 4-5 years old; 3.1%(8/258) for 5-10 years old; and 1.6% (4/258) for 10-18 years old. Among them, 89.5% were children under 3 years old. From 2016 to 2018, the positive rate of salmonella isolation in each month was between 0.79% to 14.45%, and the differences among groups were statistically significant (F=5.719, P=0.000). Among them, the separation positive rates in January, February, March and December were low (0.79%-2.1%), and the separation positive rate from April to November (9.51%-14.45%) were significantly higher than the other months (P<0.01). Conclusion From 2016 to 2018, NTS infection is the main infection among children with salmonella infectious diarrhea in our hospital, while salmonella typhi infection is predominantly sporadic. NTS infection can occur throughout the year. The high incidence season is spring, summer and autumn, and it tends to occur in infants under 3 years old