传染病信息
傳染病信息
전염병신식
INFECTIOUS DISEASE INFORMATION
2014年
3期
143-147
,共5页
崔恩博%陈素明%张成龙%王勇%贾天野%鲍春梅%张鞠玲%王欢%庞君丽%曲芬%毛远丽
崔恩博%陳素明%張成龍%王勇%賈天野%鮑春梅%張鞠玲%王歡%龐君麗%麯芬%毛遠麗
최은박%진소명%장성룡%왕용%가천야%포춘매%장국령%왕환%방군려%곡분%모원려
腹泻%大肠杆菌%沙门菌属%志贺菌属%药物耐受性%抗菌药
腹瀉%大腸桿菌%沙門菌屬%誌賀菌屬%藥物耐受性%抗菌藥
복사%대장간균%사문균속%지하균속%약물내수성%항균약
diarrhea%Escherichia coli%Salmonella%Shigella%drug tolerance%anti-bacterial agents
目的：分析我国近5年社区获得性细菌性腹泻病原菌分布及耐药特点。方法收集2009-2013年我国16省市分离自社区获得性细菌性腹泻患者新鲜大便标本的病原菌，用沙门、志贺菌属琼脂培养基、麦康凯培养基和庆大霉素培养基分离培养，挑取疑似腹泻病原菌的纯菌落用VITEKⅡ细菌鉴定仪和微量编码生化反应管鉴定，再以沙门菌、志贺菌、弧菌和致泻性大肠埃希菌血清凝集试验进行血清型分型；采用K-B法检测细菌的药物敏感性（药敏）。结果5年间共收集到我国16个省市各类腹泻病原菌10881株，包括7个菌属、22个菌种和90个血清型，其中志贺菌7632株（70.14%），弧菌1351株（12.42%），沙门菌981株（9.02%），致泻性大肠埃希菌341株（3.13%），气单胞菌302株（2.78%），邻单胞菌269株（2.47%），小肠结肠耶尔森菌5株（0.05%）。志贺菌血清型以B群中的F2a、F4a和F1a为主，沙门菌血清型以肠炎沙门菌和鼠伤寒沙门菌为主。药敏监测显示，志贺菌对头孢噻肟、头孢吡肟、头孢美唑、亚胺培南和磷霉素等敏感性较好，敏感率分别为89.7%、92.3%、96.7%、100%和97.7%；沙门菌对头孢噻肟、头孢吡肟、氨曲南、亚胺培南和磷霉素等敏感率分别为94.0%、97.9%、94.4%、100%和96.4%；气单胞菌对头孢吡肟、左氧氟沙星、亚胺培南和磷霉素等敏感率分别为80.9%、80.0%、92.6%和84.0%；致泄性大肠埃希菌对抗生素的敏感率普遍较差；弧菌对所测抗生素敏感性（氨苄西林除外）均较好。结论我国社区获得性细菌性腹泻病原菌以志贺菌属、弧菌属和沙门菌属为主，经验性抗生素治疗应该覆盖这些病原，靶向治疗应该考虑药敏试验结果。
目的：分析我國近5年社區穫得性細菌性腹瀉病原菌分佈及耐藥特點。方法收集2009-2013年我國16省市分離自社區穫得性細菌性腹瀉患者新鮮大便標本的病原菌，用沙門、誌賀菌屬瓊脂培養基、麥康凱培養基和慶大黴素培養基分離培養，挑取疑似腹瀉病原菌的純菌落用VITEKⅡ細菌鑒定儀和微量編碼生化反應管鑒定，再以沙門菌、誌賀菌、弧菌和緻瀉性大腸埃希菌血清凝集試驗進行血清型分型；採用K-B法檢測細菌的藥物敏感性（藥敏）。結果5年間共收集到我國16箇省市各類腹瀉病原菌10881株，包括7箇菌屬、22箇菌種和90箇血清型，其中誌賀菌7632株（70.14%），弧菌1351株（12.42%），沙門菌981株（9.02%），緻瀉性大腸埃希菌341株（3.13%），氣單胞菌302株（2.78%），鄰單胞菌269株（2.47%），小腸結腸耶爾森菌5株（0.05%）。誌賀菌血清型以B群中的F2a、F4a和F1a為主，沙門菌血清型以腸炎沙門菌和鼠傷寒沙門菌為主。藥敏鑑測顯示，誌賀菌對頭孢噻肟、頭孢吡肟、頭孢美唑、亞胺培南和燐黴素等敏感性較好，敏感率分彆為89.7%、92.3%、96.7%、100%和97.7%；沙門菌對頭孢噻肟、頭孢吡肟、氨麯南、亞胺培南和燐黴素等敏感率分彆為94.0%、97.9%、94.4%、100%和96.4%；氣單胞菌對頭孢吡肟、左氧氟沙星、亞胺培南和燐黴素等敏感率分彆為80.9%、80.0%、92.6%和84.0%；緻洩性大腸埃希菌對抗生素的敏感率普遍較差；弧菌對所測抗生素敏感性（氨芐西林除外）均較好。結論我國社區穫得性細菌性腹瀉病原菌以誌賀菌屬、弧菌屬和沙門菌屬為主，經驗性抗生素治療應該覆蓋這些病原，靶嚮治療應該攷慮藥敏試驗結果。
목적：분석아국근5년사구획득성세균성복사병원균분포급내약특점。방법수집2009-2013년아국16성시분리자사구획득성세균성복사환자신선대편표본적병원균，용사문、지하균속경지배양기、맥강개배양기화경대매소배양기분리배양，도취의사복사병원균적순균락용VITEKⅡ세균감정의화미량편마생화반응관감정，재이사문균、지하균、호균화치사성대장애희균혈청응집시험진행혈청형분형；채용K-B법검측세균적약물민감성（약민）。결과5년간공수집도아국16개성시각류복사병원균10881주，포괄7개균속、22개균충화90개혈청형，기중지하균7632주（70.14%），호균1351주（12.42%），사문균981주（9.02%），치사성대장애희균341주（3.13%），기단포균302주（2.78%），린단포균269주（2.47%），소장결장야이삼균5주（0.05%）。지하균혈청형이B군중적F2a、F4a화F1a위주，사문균혈청형이장염사문균화서상한사문균위주。약민감측현시，지하균대두포새우、두포필우、두포미서、아알배남화린매소등민감성교호，민감솔분별위89.7%、92.3%、96.7%、100%화97.7%；사문균대두포새우、두포필우、안곡남、아알배남화린매소등민감솔분별위94.0%、97.9%、94.4%、100%화96.4%；기단포균대두포필우、좌양불사성、아알배남화린매소등민감솔분별위80.9%、80.0%、92.6%화84.0%；치설성대장애희균대항생소적민감솔보편교차；호균대소측항생소민감성（안변서림제외）균교호。결론아국사구획득성세균성복사병원균이지하균속、호균속화사문균속위주，경험성항생소치료응해복개저사병원，파향치료응해고필약민시험결과。
Objective To analyze the characteristics of the community-acquired bacterial diarrheal pathogen spectrum and drug resistance in China during 5 years. Methods The strains isolated from the stool samples of patients with community-acquired bacterial diarrhea were collected from 16 provinces or cities in China during 2009-2013. The bacteria were incubated with Salmo-nella, Shigella agar, gentamicin agar and MacConkey agar plate and identification of pathogens suspected to be the cause of diarrhea was performed by VITEKⅡinstrument and biochemical reaction trace coding tube. Then, Salmonella, Shigella, Vibrio and diarrhea-genic Escherichia coli were serotyped by serum agglutination test. K-B method was used for antimicrobial susceptibility testing of bacterial pathogens. Results A total of 10 881 strains of diarrheal pathogens, including 7 genus, 22 species and 90 serotypes were isolated from diarrheal patients from 16 provinces or cities in China during 5 years. There were 7632 (70.14%) strains of Shigella, 1351 (12.42%) strains of Vibrio, 981 (9.02%) strains of Salmonella , 341 (3.13%) strains of diarrheagenic Escherichia coli, 302 (2.78%) strains of Aeromonas, 269 (2.47%) strains of Plesiomonas, and 5 (0.05%) strains of Yersinia enterocolitica. The major serotypes of Shigella were F2a, F4a and F1a belonging to group B and the major serotypes of Salmonella were Salmonella enteritidis and Salmonella typhimurium. Drug sensitivity monitoring showed that Shigella had better sensitivity to cefotaxime, cefepime, cefmetazole, imipenem and fosfomycin, with the sensitivity rates of 89.7%, 92.3%, 96.7%, 100%and 97.7%; the sensitive rates of Salmonella to cefotaxime, cefepime, aztreonam, imipenem and fosfomycin were 94.0%, 97.9%, 94.4%, 100% and 96.4%; the sensitive rates of Aeromonas to cefepime, levofloxacin, imipenem and fosfomycin were 80.9%, 80.0%, 92.6% and 84.0%; diarrheagenic Escherichia coli had poor sensitivity to antibiotics generally; Vibrio had good sensitivity to antibiotics excluding ampicillin. Conclusions Shigella, Vibrio and Salmonella are the major community-acquired bacterial diarrheal pathogens in China. Empiric antibiotic therapy should be directed against these pathogens, and targeted therapy should take the results of drug sensitivity testing into consideration.
