CAJ | 학술논문

目的调查腹泻儿童临床分离志贺菌的流行及其耐药性,为细菌性痢疾临床治疗和感染控制提供理论依据.方法收集2008年1月至2010年12月浙江萧山医院就诊的≤14岁腹泻患儿粪便分离的志贺菌156株,纸片扩散检测其抗菌药物的耐药性,纸片确认试验检测产超广谱β内酰胺酶(ESBLs)；采用细菌基因组重复序列聚合酶链反应(REP-PCR)检测产ESBLs宋内志贺菌的分子流行病学特征.结果 156株志贺菌中主要为宋内志贺菌(130株,占83.3％)和福氏志贺菌(26株,占16.7％),81株志贺菌产ESBLs,阳性率为51.9％,各年的阳性率分别为2008年32.0％、2009年41.4％、2010年59.8％.药敏结果显示,产ESBLs志贺菌对氨苄西林、复方新诺明、头孢噻肟、哌拉西林耐药率均＞90％,而对头孢吡肟、头孢他啶、左氧氟沙星、环丙沙星耐药率较低；产ESBLs志贺菌与非产ESBLs志贺菌相比,对哌拉西林(100％ vs.77.3％)、头孢噻肟(100％ vs.0)、头孢他啶(14.8％ vs.0)、头孢吡肟(28.4％ vs.0)、复方新诺明(95.1％ vs.86.7％)的耐药率均较高(x2值分别为20.605,156.000,12.037,24.979,45.040;P均＜0.05),未发现亚胺培南、哌拉西林-他唑巴坦耐药菌株.74株产ESBLs宋内志贺菌共分为7个基因型:A型50株,B型12株,C型8株,D、E、F、G型各1株.结论分离自腹泻患儿的志贺菌产ESBLs阳性率较高,且有逐年增加的趋势；近年来宋内志贺菌存在同一克隆株A型的流行；哌拉西林-他唑巴坦可作为临床治疗儿童感染产ESBLs志贺菌的首选药物.
목적 조사복사인동림상분리지하균적류행급기내약성,위세균성이질림상치료화감염공제제공이론의거.방법 수집2008년1월지2010년12월절강소산의원취진적≤14세복사환인분편분리적지하균156주,지편확산검측기항균약물적내약성,지편학인시험검측산초엄보β내선알매(ESBLs)；채용세균기인조중복서렬취합매련반응(REP-PCR)검측산ESBLs송내지하균적분자류행병학특정.결과 156주지하균중주요위송내지하균(130주,점83.3％)화복씨지하균(26주,점16.7％),81주지하균산ESBLs,양성솔위51.9％,각년적양성솔분별위2008년32.0％、2009년41.4％、2010년59.8％.약민결과현시,산ESBLs지하균대안변서림、복방신낙명、두포새우、고랍서림내약솔균＞90％,이대두포필우、두포타정、좌양불사성、배병사성내약솔교저；산ESBLs지하균여비산ESBLs지하균상비,대고랍서림(100％ vs.77.3％)、두포새우(100％ vs.0)、두포타정(14.8％ vs.0)、두포필우(28.4％ vs.0)、복방신낙명(95.1％ vs.86.7％)적내약솔균교고(x2치분별위20.605,156.000,12.037,24.979,45.040;P균＜0.05),미발현아알배남、고랍서림-타서파탄내약균주.74주산ESBLs송내지하균공분위7개기인형:A형50주,B형12주,C형8주,D、E、F、G형각1주.결론 분리자복사환인적지하균산ESBLs양성솔교고,차유축년증가적추세；근년래송내지하균존재동일극륭주A형적류행；고랍서림-타서파탄가작위림상치료인동감염산ESBLs지하균적수선약물.
Objective To investigate the prevalence and antibiotic resistance of Shigella isolated from children with diarrhea for the guidance of clinical treatment and prevention and control of bacillary dysentery.Method A total of 156 strains of Shigella were isolated from feces of children with diarrhea in Zhejiang Xiaoshan Hospital from January 2008 to December 2010.The antimicrobial resistance of the strains was detected by disk diffusion method and the extended-spectrum beta-lactamases (ESBLs) in these isolates were determined using phenotypic confirmatory test; the isolates of ESBLs producing Shigella sonnei were analyzed by REP-PCR.Result Among 156 strains of Shigella isolated,the most common groups were Shigella sonnei (130 strains,accounting for 83.3％) and Shigella fleaneri (26 strains,accounting for 16.7％),and 81 (51.9％) strains were identified as ESBLs producers,and the positive rates in 2008,2009 and 2010 were 32.0％,41.4％ and 59.8％,respectively.The results of antibiotic susceptibility test displayed that the resistance rates of ESBLs producing Shigella to ampicillin,cotrimoxazole,cefotaxime,piperacillin were higher than 90％.However,the resistance rates to cefepime,ceftazidime,levofloxacin and ciprofloxacin were low; The resistance of ESBLs producing strains to piperacillin (100％ vs.77.3％),cefotaxime(100％ vs.0),ceftazidime(14.8％ vs.0),cefepime(28.4％ vs.0),cotrimoxazole(95.1％vs.86.7％) was significantly higher than that of non-ESBLs producing strains (x2 =20.605,156.000,12.037,24.979,45.040,respectively ;P ＜ 0.05).No isolate was resistant to piperacillin/tazobactam and imipenem.There were 7 genotypes among 74 ESBLs producing Shigella sonnei,respectively type A (50),type B (12),type C (8),type D (1),type E (1),type F (1),and type G (1).Conclusion The isolation rate of ESBLs-producing isolate was high in Shigella from pediatric patients with diarrhea,and the number is going up year by year,and these ESBLs producing Shigella sonnei strains in genotype A are dominant in recent years,Piperacillin/tazobactam is the drug of choice for children with ESBLs producing Shigella infection.