厦门地区156株儿童感染性腹泻沙门菌的血清学分型及耐药性分析

目的 分析致儿童感染性腹泻的沙门菌的分布特征及耐药状况,为临床诊断及治疗提供依据。方法 对2009-2014年期间来我院就诊的3 287例感染性腹泻患儿,取大便标本进行沙门菌增菌培养及分离鉴定,采用BD Phoenix100全自动细菌鉴定药敏分析系统进行沙门菌属确认和药敏试验,并对确认菌株行血清学分型。结果 分离出156株沙门菌分属于5个群,23种不同血清型,其中B群鼠伤寒沙门菌和D群肠炎沙门菌分离率较高,分别占53.8％和12.2%。夏秋季节5-10月份检出率5.0%,高于冬春季节11-4月检出率3.2%,差异有统计学意义（χ2=5.93,P=0.015）。对氨苄西林耐药率高达59.6%,对氯霉素、复方新诺明、环丙沙星和三代头孢菌素均有不同程度耐药,对β-内酰胺类加酶抑制剂的哌拉西林/他唑巴坦基本敏感。超广谱β-内酰胺酶（ESBLs）检出率高达16.7%,多重耐药菌（MDRO）检出率17.3%。结论 本地区儿童感染性腹泻沙门菌以B群的鼠伤寒沙门菌居首位,其次为D群肠炎沙门菌。夏秋季节检出率明显高于冬春季节。耐药现象不容忽视,临床应依据药敏结果选用抗菌药物。

Serotype diversity and drug resistance of 156 Salmonella of children infectious diarrhea,Xiamen region

Objective To provide the main serotype,age diversity and drug resistance of Salmonella which infected children in Xiamen region during the year 2009 to 2014 and guide the rational use of antimicrobial drugs. Methods We firstly identified the 156 Salmonella strains in Xiamen region from January,2009 to the December 2014 and performed the susceptibility by using the BD Phoenix100 automated the bacterial identification and drug sensitivity analyze the system. Furthermore,we gave the serological identification. Results 156 Salmonella strains were divided into 5 group and 23 different serotypes,the prevalent serotypes were Salmonella Typhimurium(53.8%)and Salmonella typhi(12.2%). The resistant rate to ampicillin was as high as 59.6%,there were varying degrees of resistance to chloramphenicol,trimethoprim/sulfamethoxazole,ciprofloxacin and third generation cephalosporins. Salmonella isolates were highly sensitive to piperacillin / tazobactam. The rate(5.0%)of summer and fall was higher than that of winter and spring season(3.2%),and the difference was statistically significant(χ2=5.93,P=0.015). The rate of Extended-Spectrum Beta-Lactamases(ESBLs)was as high as 16.7%,the detection rate of Multi-Drug Resistant Organisms(MDRO)was 17.3%. Conclusion Children infectious diarrhea in Xiamen salmonella in B group of salmonella Typhimurium in the lead,followed by D group of enteritis of salmonella. Summer and fall detection rate significantly higher than the winter and spring season. Drug resistance phenomenon should not be ignored and the choice of drug should be according to the results of drug susceptibility.