CAJ | 학술논문

目的分析1994-2013年广西地区伤寒流行特征、菌株耐药特征及其变迁.方法采用描述流行病学方法分析1994-2013年广西地区伤寒疫情报告资料,对分离自伤寒病例475株沙门菌,利用纸片扩散法及肉汤微量稀释法检测抗菌药物最小抑菌圈和抑菌浓度(MIC),依据CLSI 2012版敏感判定标准,判定菌株的耐药情况.结果 20年间广西地区共报告伤寒病例57 928例,年均发病率为6.29/10万,病死率为0.03％.＜20岁人群发病较高,发病无性别差异,病例以农民和学生为主,主要分布在广西北部地区,全年均有发病,发病高峰在5-10月.2001-2013年发生13起大的暴发疫情,传播方式以水型为主.475株菌对第三代头孢类抗生素头孢噻肟和氟喹诺酮类诺氟沙星的敏感率为100％,对四环素、氯霉素、氨苄西林、庆大霉素的敏感率约为98％,对环丙沙星的敏感率为89.89％;对链霉素、复方新诺明的敏感性较低,为67.73％和65.89％.发现1株环丙沙星耐药、47株环丙沙星敏感性降低的菌株.暴发株与散发株耐药情况无差别.有28株菌耐≥3种抗生素,首次发现1株同时对氨苄西林、氯霉素、链霉素、复方新诺明、四环素、萘啶酸(ACSSxT-NAL)耐药的多重耐药菌株.多耐药株多见于伤寒小范围暴发疫情.结论广西地区伤寒发病水平仍较高,且菌株出现对临床常用的氟喹诺酮类药物敏感性降低及多重耐药现象,应加强疫情及耐药监测.
목적 분석1994-2013년엄서지구상한류행특정、균주내약특정급기변천.방법 채용묘술류행병학방법분석1994-2013년엄서지구상한역정보고자료,대분리자상한병례475주사문균,이용지편확산법급육탕미량희석법검측항균약물최소억균권화억균농도(MIC),의거CLSI 2012판민감판정표준,판정균주적내약정황.결과 20년간엄서지구공보고상한병례57 928례,년균발병솔위6.29/10만,병사솔위0.03％.＜20세인군발병교고,발병무성별차이,병례이농민화학생위주,주요분포재엄서북부지구,전년균유발병,발병고봉재5-10월.2001-2013년발생13기대적폭발역정,전파방식이수형위주.475주균대제삼대두포류항생소두포새우화불규낙동류낙불사성적민감솔위100％,대사배소、록매소、안변서림、경대매소적민감솔약위98％,대배병사성적민감솔위89.89％;대련매소、복방신낙명적민감성교저,위67.73％화65.89％.발현1주배병사성내약、47주배병사성민감성강저적균주.폭발주여산발주내약정황무차별.유28주균내≥3충항생소,수차발현1주동시대안변서림、록매소、련매소、복방신낙명、사배소、내정산(ACSSxT-NAL)내약적다중내약균주.다내약주다견우상한소범위폭발역정.결론 엄서지구상한발병수평잉교고,차균주출현대림상상용적불규낙동류약물민감성강저급다중내약현상,응가강역정급내약감측.
Objective Through analyzing the typhoid epidemics and to determine and monitor regional resistance characteristics of the shift of drug resistant profile on Salmonella (S.) Typhi,to understand the related epidemiological characteristics of typhoid fever and to provide evidence for the development of strategies,in Guangxi.Methods Data of typhoid fever from surveillance and reporting system between 1994 to 2013 was collected and statistically analyzed epidemiologically.The susceptibility of 475 S.Typhi isolates from patients on ten antibiotics was tested by broth micro-dilution method and minimum inhibition concentration was obtained and interpreted based on the CLSI standard.Results From 1994 to 2013,a total of 57 928 cases of typhoid fever were reported in Guangxi province with an annual incidence of 6.29/100 000 and mortality as 0.03％.The higher incidence was observed in the population under 20 years of age.There was no significant difference on incidence between male and female,but farmers and students were among the hardest hit groups.More cases were seen from the northern part of the province.Cases appeared all year round with the peak from May to October.A total of 13 major outbreaks during 2001 to 2013 were reported and the main transmission route was water-borne.All the strains were sensitive to third generation cephalosporins cefotaxime and fluoroquinolones norfloxacin.The susceptibility rates to tetracycline,chloramphenicol,ampicillin and gentamicin was around 98％ but relative lower susceptible rate to ciprofloxacin was seen as 89.89％.The lowest susceptibility was found for streptomycin and sulfamethoxazole agents,with the rates as 67.73％ and 65.89％,respectively.One strain was found to have been resistant to ciprofloxacin and another 47 isolates with reduced susceptibility to ciprofloxacin.Twenty eight isolates were found to be resistant to multiple antibiotics and one displayed ampicillin,chloramphenicol,streptomycin,sulfamethoxazole tetracycline and nalidixic acid (ACSSxT-NAL) resistance profile.This was the first report in China.Multi-drug resistant strains were frequently isolated from small scale outbreaks of typhoid fever.Conclusion The incidence of typhoid fever in Guangxi was still high and some strains showed multi-drug resistance and reduced susceptibility to ciprofloxacin,indicating that the surveillance and monitor programs on drug resistance of S.Typhi should be strengthened,to prevent large scale outbreaks of typhoid fever in this province.