CAJ | 학술논문

目的：了解上海地区急性细菌感染性腹泻患儿中弯曲菌感染流行病学特点。方法流行病学调查。收集2011年1月1日至2012年12月31日复旦大学附属儿科医院门诊及住院临床诊断为急性细菌感染性腹泻患儿6641例的粪便标本6641份，在微需氧环境下对患儿粪便标本进行弯曲菌分离培养，采用多重PCR及基质辅助激光解析/吸附电离飞行时间质谱技术（ MALDI-TOF ）对弯曲菌进行鉴定。采用纸片扩散法进行药敏试验，药物敏感性试验判断标准采用欧洲抗生素药物敏感试验委员会（ EUCAST）标准。采用脉冲场凝胶电泳（ PFGE）进行分型。采用SPSS 16．0软件进行统计分析。结果共分离到305株弯曲菌，感染率为4．6％（305/6641），其中空肠弯曲菌感染率3．6％（240株）；结肠弯曲菌感染率1．0％（65株）。1岁以上儿童感染率为6．2％（209/3385），明显高于1岁以内儿童2．9％（96/3256），χ2＝35．98，P＜0．001。冬春季感染率为6．8％（138/2040），明显高于其他月份3．6％（167/4601），χ2＝28．59，P＜0．001。弯曲菌对环丙沙星的耐药率为91．5％（279/305），对红霉素的耐药率为11．8％（36/305）。检测到A～I 9种空肠弯曲菌PFGE分型。相似度分别为A型65．1％～100．0％，B型67．6％～100．0％，C型61．7％～100．0％，D型59．0％～100．0％，F型2株71．4％，H型2株80．0％，Ⅰ型54．4％～90．9％， E型和G型仅1株。结论弯曲菌是上海地区急性细菌性感染儿童主要致病菌之一，1岁以上儿童为易感人群，冬春季高发，以多克隆散发感染为特点。该致病菌对环丙沙星已高度耐药，对红霉素仍较敏感。（中华检验医学杂志，2014，37：743-747）
목적：료해상해지구급성세균감염성복사환인중만곡균감염류행병학특점。방법류행병학조사。수집2011년1월1일지2012년12월31일복단대학부속인과의원문진급주원림상진단위급성세균감염성복사환인6641례적분편표본6641빈，재미수양배경하대환인분편표본진행만곡균분리배양，채용다중PCR급기질보조격광해석/흡부전리비행시간질보기술（ MALDI-TOF ）대만곡균진행감정。채용지편확산법진행약민시험，약물민감성시험판단표준채용구주항생소약물민감시험위원회（ EUCAST）표준。채용맥충장응효전영（ PFGE）진행분형。채용SPSS 16．0연건진행통계분석。결과공분리도305주만곡균，감염솔위4．6％（305/6641），기중공장만곡균감염솔3．6％（240주）；결장만곡균감염솔1．0％（65주）。1세이상인동감염솔위6．2％（209/3385），명현고우1세이내인동2．9％（96/3256），χ2＝35．98，P＜0．001。동춘계감염솔위6．8％（138/2040），명현고우기타월빈3．6％（167/4601），χ2＝28．59，P＜0．001。만곡균대배병사성적내약솔위91．5％（279/305），대홍매소적내약솔위11．8％（36/305）。검측도A～I 9충공장만곡균PFGE분형。상사도분별위A형65．1％～100．0％，B형67．6％～100．0％，C형61．7％～100．0％，D형59．0％～100．0％，F형2주71．4％，H형2주80．0％，Ⅰ형54．4％～90．9％， E형화G형부1주。결론만곡균시상해지구급성세균성감염인동주요치병균지일，1세이상인동위역감인군，동춘계고발，이다극륭산발감염위특점。해치병균대배병사성이고도내약，대홍매소잉교민감。（중화검험의학잡지，2014，37：743-747）
Objective To assess the prevalence of Campylobacter in the children with acute bacterial diarrhea in Shanghai.Methods Epidemiological survey.Totally 6 641 children with acute bacterial infectious diarrhea from outpatients and inpatients in Children′s Hospital of Fudan University were submitted to the investigation during January 2011 to December 2012.The Campylobacter was isolated from stool samples collected from subjects in micro aerobic environment and identified by both multi-PCR and matrix-assisted laser desorption ionization-time-of-flight mass spectrometry ( MALDI-TOF MS ) .Antimicrobial susceptibility tests were assayed by disk-diffusion method according to EUCAST standard.The isolates molecular typing was done by PFGE.SPSS16.0 was used to analyze the results.Results A total number of 6 641 subjects were enrolled, among them, 305 patients were infected with Campylobacter.The prevalence rate was 4.6%(305/6 641).Among the infected patients, 240 patients were infected with Campylobacter jejuni and 65 patients were infected with Campylobacter coli, the infectious rates of these two pathogenic bacteria were 3.6%and 1.0%, respectively.The peak infectious rate in patients older than 1 year of age was 6.2%(209/3 385) which was higher than that in children under 1 year of age (2.9%, 96/3 256),χ2 =35.98,P<0.001.The infectious rate in winter and spring (6.8%, 138/2 040) was higher than that in the other seasons ( 3.6%, 167/4 601 ) ,χ2 =28.59, P <0.001.Antimicrobial susceptibility test results showed that 91.5%( 279/305 ) isolates were resistant to ciprofloxacin and 11.8%( 36/305 ) isolates were resistant to erythromycin.A total of 9 genotypes of Campylobacter were found by PFGE cluster analysis.The similarity were ranged from 65.1%-100.0%for type A, 67.6%-100.0%for type B, 61.7%-100.0%for type C, 59.0%-100.0%for type D, 71.4%for type F, 80.0%for type H, 54.4%-90.9%for type I, and only one strain was classified as type E and G.Conclusions Campylobacter is a major pathogenic bacteria associated with acute bacterial infectious diarrhea in children especially in children older than 1 year of age in Shanghai.The prevalent pattern of this pathogen was sporadic and the sharp peak was in winter and spring.The isolates are highly resistant to ciprofloxacin but still sensitive to erythromycin.