CAJ | 학술논문

目的：了解近3年上海地区儿童细菌性痢疾的流行特征和志贺菌的血清型分布及耐药模式。方法以复旦大学附属儿科医院2010年7月—2012年12月肠道门诊临床诊断为“细菌性肠炎”的患儿作为监测对象，开展志贺菌以及其他肠道致病菌的病原学检测。收集患儿的临床资料、粪便肠道菌分离结果、志贺菌药物敏感性检测结果，并进行分析。结果3105例临床诊断“细菌性肠炎”的腹泻儿童中，144例（4．6％）粪便培养确诊系志贺菌感染，志贺菌的总检出率低于非伤寒沙门菌（18．1％）和弯曲菌（6．7％）。3年中志贺菌每年9—10月平均检出率10．0％，明显高于年平均检出率4．6％。144株志贺菌中B 群福氏志贺菌46株（31．9％），D 群宋内志贺菌98株（68．1％）。B 群福氏志贺菌包括6种血清型，依次为2a 型（56．8％）、2c型（18．9％）、1a 型（10．8％）、4c 型（8．1％）、3a 型（2．7％）和 Y 型变种（2．7％）。120株菌行药物敏感性检测，志贺菌对氨苄西林、萘啶酸、链霉素耐药率均超过95％；对甲氧苄啶-磺胺甲口恶唑、四环素、庆大霉素的耐药率分别为88．3％、87．5％和60．0％；对头孢噻肟、头孢吡肟和头孢他啶的耐药率分别为49．2％、24．2％和18．3％；对阿莫西林-克拉维酸耐药率为18．3％；对环丙沙星和氧氟沙星的耐药率分别为16．7％和15．0％。对化学结构不同的3种及以上抗菌药物的多重耐药株占91．7％。结论D群宋内志贺菌是目前该院儿童细菌性痢疾的优势型，B 群福氏志贺菌中2a 型为最流行的血清型，2c 型为常见的血清型。志贺菌等细菌对多种临床常用抗菌药物耐药，应持续加强儿童细菌性痢疾以及其他感染性腹泻的监测，从而为临床治疗提供依据。
목적：료해근3년상해지구인동세균성이질적류행특정화지하균적혈청형분포급내약모식。방법이복단대학부속인과의원2010년7월—2012년12월장도문진림상진단위“세균성장염”적환인작위감측대상，개전지하균이급기타장도치병균적병원학검측。수집환인적림상자료、분편장도균분리결과、지하균약물민감성검측결과，병진행분석。결과3105례림상진단“세균성장염”적복사인동중，144례（4．6％）분편배양학진계지하균감염，지하균적총검출솔저우비상한사문균（18．1％）화만곡균（6．7％）。3년중지하균매년9—10월평균검출솔10．0％，명현고우년평균검출솔4．6％。144주지하균중B 군복씨지하균46주（31．9％），D 군송내지하균98주（68．1％）。B 군복씨지하균포괄6충혈청형，의차위2a 형（56．8％）、2c형（18．9％）、1a 형（10．8％）、4c 형（8．1％）、3a 형（2．7％）화 Y 형변충（2．7％）。120주균행약물민감성검측，지하균대안변서림、내정산、련매소내약솔균초과95％；대갑양변정-광알갑구악서、사배소、경대매소적내약솔분별위88．3％、87．5％화60．0％；대두포새우、두포필우화두포타정적내약솔분별위49．2％、24．2％화18．3％；대아막서림-극랍유산내약솔위18．3％；대배병사성화양불사성적내약솔분별위16．7％화15．0％。대화학결구불동적3충급이상항균약물적다중내약주점91．7％。결론D군송내지하균시목전해원인동세균성이질적우세형，B 군복씨지하균중2a 형위최류행적혈청형，2c 형위상견적혈청형。지하균등세균대다충림상상용항균약물내약，응지속가강인동세균성이질이급기타감염성복사적감측，종이위림상치료제공의거。
Objective To examine the prevalence and pattern of antimicrobial resistance among the Shigella isolates from children in Shanghai during the period from 2010 to 2012.Methods All cases with a clinical diagnosis of bacterial diarrhea were monitored at the Enteric Diseases Clinic of a major sentinel pediatric hospital in Shanghai from July 2010 through December 2012.Shigella species and other major intestinal bacteria were routinely isolated from stool.Shigella isolates were also serotyped and tested for antimicrobial susceptibility.The clinical and microbiological data were analyzed.Results A total of 3 105 children with probable bacterial enteritis were included in the surveillance.Shigella strain was isolated from 144 (4.6%) diarrheal cases.The overall prevalence of Shigella strain was lower than that of non-typhoid Salmonella (18.1%)and Campylobacter (6.7%).The average prevalence of Shigella isolates was significantly higher between September and October (10.0%)than the annual average prevalence (4.6%).The median age was 46.5 months for the children with laboratory-confirmed shigellosis. Of the 144 Shigella isolates, 98(68.1%)were Shigella sonnei and 46 (31.9%)wereShigella flexneri .Shigella flexneri was further classifiedinto 6 serotypes (2a:56.8%,2c:18.9%,1a:10.8%,4c:8.1%,3a:2.7% and Y variant:2.7%).Among the 120Shigella isolates tested for antimicrobial susceptibility usingKirbyBauer method, more than 95% were resistant to ampicillin,nalidixic acid,and streptomycin,88.3% to trimethoprimsulfamethoxazole,87.5% to tetracyline,60.0% togentamicin,49.2% to cefotaxime,24.2% to cefepime,18.3% to ceftazidime,18.3% to amoxicillinclavulanate,16.7% tociprofloxacin and 15.0% to ofloxacin.Overall,91.7% of the Shigella isolates showed resistance to three or more classes ofantibiotics.Conclusions Shigella sonnei is the most frequently isolated Shigella species.Shigella flexneri 2a is the mostprevalent serotype followed by 2c serotype.Resistance to the clinically important antibiotics is high among Shigella species inShanghai.Ongoing local monitoring of shigellosis and other bacterial diarrhea should be enhanced.Effective empiric antibiotictherapy for shigellosis should be based on local antimicrobial susceptibility data.