2003 - 2015年西安市感染性腹泻细菌病原学监测结果分析

目的 了解西安市2003-2015年感染性腹泻细菌病原谱及其变迁情况，为其防治提供参考依据。方法 从西安市感染性腹泻监测哨点医院就诊病例的粪便样本中培养分离出病原菌，对其分布和变迁情况进行统计学分析。结果 共检出病原菌5种305株，检出率8.10%（305/3 767）。其中志贺菌检出最多（60.00%,183/305），其次是沙门菌（24.26%,74/305），致病性大肠杆菌（10.49%,32/305），副溶血性弧菌（4.59%,14/305），O157∶H7肠出血性大肠杆菌（0.33%,1/305），非O1和O139霍乱弧菌（0.33%,1/305）。男性病原菌检出率为 8.12%（167/2 056），女性为8.07%（138/1 711）；7 - 8月份是病原菌检出高峰期；10～19岁年龄组病原菌检出率最高，达41.56%（101/243）。志贺菌属中B群为优势菌型（59.02%,108/183），其次是D群（28.96%,53/183）,A群（8.20%,15/183）和C群（3.82%,7/183）；福氏志贺菌（B群）构成比逐渐下降( χ2趋势 = 15.14，P ＜0.05)，宋内志贺菌（D群）构成比逐渐上升( χ2趋势=7.59，P ＜0.05)。结论 西安市感染性腹泻病原菌以志贺菌为主，其次是沙门菌和致病性大肠杆菌。应注意志贺菌优势菌型的变迁并加强副溶血性弧菌和肠出血性大肠杆菌的主动监测。

Pathogenic detection of infectious diarrhea in patients in Xi'an city from 2003 to 2015

Objective The aim of this study was to investigate the distribution and the change of pathogens causing bacterial diarrhea in patients of Xi'an city from 2003 to 2015, so as to provide reference for clinical diagnosis and treatment. Methods Distribution and the change of pathogens isolated from patients with bacterial diarrhea in hospitals for surveillance were analyzed statistically. Results A total of 305 isolates of five pathogenic species were isolated and the detection rate was 8.10% (305/3767). Shigella was the predominant strain, accounting for 60.00% (183/305), followed by Salmonella, accounting for 24.26% (74/305), Enteropathogenic E. coli, accounting for 10.49% (32/305), Vibrio parahaemolyticus, accounting for 4.59% (14/305), Enterohemorrhagic E. coli O157:H7, accounting for 0.33% (1/305) and Vibrio cholerae non O1 or O139, accounting for 0.33% (1/305). The detection rate in male was 8.12%（167/2056） and female was 8.07%（138/1711）. The peak of bacterial pathogens detection was from July to August. The detection rate in patients aged from 10 to 19 was the highest (41.56%, 101/243). Of the Shigella strains, 108 were group B (59.02%, 108/183), 53 were group D (28.96%, 53/183), 15 were group A (8.20%, 15/183) and seven were group C (3.82%, 7/183). The constituent ratio of Shigella flexneri (group B) showed an obvious downtrend (χ2=15.14, P <0.05) while Shigella sonnei (group D) showed an obvious uptrend (χ2=7.59, P <0.05). Conclusion Shigella was the main pathogens in bacterial diarrhea in Xi'an city, secondly Salmonella and Enteropathogenic E. coli. The change of dominant pattern of Shigella need more attention. The local medical workers should pay attention to the Vibrio parahaemolyticus and Enterohemorrhagic E. coli O157:H7 when monitoring patients' samples.