CAJ | 학술논문

目的了解致泻性大肠埃希菌(DEC)所致儿童急性细菌性腹泻的致病菌类型、流行特征和抗菌药物耐药模式.方法 2012年6月至2014年6月复旦大学附属儿科医院肠道门诊诊断为急性细菌性腹泻的2 071例患儿作为监测对象,开展包括肠致病性大肠埃希菌(EPEC)、肠产毒素性大肠埃希菌(ETEC)、肠侵袭性大肠埃希菌(EIEC)和肠出血性大肠埃希菌(EHEC)及其他肠道致病菌的病原学检测,使用改良K-B纸片法检测菌株的抗菌药物敏感性.组间比较采用卡方检验.结果 2 071例患儿的标本中检出DEC阳性者145例,检出率为7.0％.分离DEC 148株(3例混合感染),包括EPEC106株(71.6％)、ETEC 24株(16.2％)、EIEC 16株(10.8％)和EHEC 2株(1.4％).145例DEC感染患儿中位年龄14个月,＜2岁占62.8％.检测125株DEC对氨苄西林、甲氧苄氨嘧啶-磺胺异(噁)唑、庆大霉素的耐药率,分别为55.2％、35.2％和23.2％;对头孢噻肟、头孢吡肟、头孢他啶的耐药率分别为28.0％、27.2％和8.8％;对阿莫西林-克拉维酸钾、环丙沙星、氧氟沙星的耐药率分别为5.6％、4.0％和4.0％.EIEC对头孢噻肟、头孢吡肟和头孢他啶的耐药率分别为50.0％、43.8％和25.0％,高于EPEC、ETEC和EHEC.结论 DEC为本次研究中儿童细菌性腹泻的重要病原,以EPEC和ETEC较常见.
목적 료해치사성대장애희균(DEC)소치인동급성세균성복사적치병균류형、류행특정화항균약물내약모식.방법 2012년6월지2014년6월복단대학부속인과의원장도문진진단위급성세균성복사적2 071례환인작위감측대상,개전포괄장치병성대장애희균(EPEC)、장산독소성대장애희균(ETEC)、장침습성대장애희균(EIEC)화장출혈성대장애희균(EHEC)급기타장도치병균적병원학검측,사용개량K-B지편법검측균주적항균약물민감성.조간비교채용잡방검험.결과 2 071례환인적표본중검출DEC양성자145례,검출솔위7.0％.분리DEC 148주(3례혼합감염),포괄EPEC106주(71.6％)、ETEC 24주(16.2％)、EIEC 16주(10.8％)화EHEC 2주(1.4％).145례DEC감염환인중위년령14개월,＜2세점62.8％.검측125주DEC대안변서림、갑양변안밀정-광알이(오)서、경대매소적내약솔,분별위55.2％、35.2％화23.2％;대두포새우、두포필우、두포타정적내약솔분별위28.0％、27.2％화8.8％;대아막서림-극랍유산갑、배병사성、양불사성적내약솔분별위5.6％、4.0％화4.0％.EIEC대두포새우、두포필우화두포타정적내약솔분별위50.0％、43.8％화25.0％,고우EPEC、ETEC화EHEC.결론 DEC위본차연구중인동세균성복사적중요병원,이EPEC화ETEC교상견.
Objective To investigate the pathotypes,epidemiological characteristics and antimicrobial resistance of diarrheagenic Escherichia coli (DEC) in children with acute bacterial diarrhea in Shanghai.Methods A total of 2 071 outpatient children with probable acute bacterial diarrhea referred to the enteric clinic of Children's Hospital of Fudan University during June 2012 to June 2014 were enrolled in our study.The stool samples were processed for routine microbiologic and biochemistry tests to identify enteric bacteria,including enteropathogenic Escherichia coli (EPEC),enterotoxigenic Escherichia coli (ETEC),enteroinvasive Escherichia coli (EIEC) and enterohemorrhagic Escherichia coli (EHEC).Kirby-Bauer method was used to identify the antibiotic sensitivity.Difference of means between groups was compared by chi-square test.Results Of 2 071 enrolled children,DEC were identified in 145 (7.0 ％)cases.148 strains were isolated with three of mix infection strains.All DEC isolates in this study included 106 (71.6％) EPEC,24 (16.2％) ETEC,16(10.8％) EIEC and 2(1.4％) EHEC.The median ages of diarrheal children with DEC infections were 14 months (range:3 months to 13 years) and 62.8％ of them were ＜2 years.Among 125 DEC isolates tested for antimicrobial susceptibility,the rates of resistance to ampicillin,trimethoprim-sulfamethoxazole,cefotaxime,cefepime,gentamicin,ceftazidime,amoxicillinclavulanate,ciprofloxacin,and ofloxacin in a descending order were 55.2％,35.2％,28.0％,27.2％,23.2％,8.8％,5.6％,4.0％ and 4.0％,respectively.Resistance rates of EIEC to cefotaxime,cefepime and ceftazidime were 50.0％,43.8％ and 25.0％,respectively,which were higher than those of EPEC,ETEC and EHEC.Conclusion DEC is the important enteric bacteria that causes bacterial diarrhea in children in this study.