【摘要】 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 3 105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。更多还原

【Abstract】 Objective To examine the prevalence and pattern of antimicrobial resistance among the Shigella isolates from children in Shanghai during the period from2010 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 December2012.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 of3 105 children with probable bacterial enteritis were included in the surveillance.Shigellastrain was isolated from144(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 Shigellaisolates 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 laboratoryconfirmed shigellosis. Of the 144 Shigella isolates,98(68.1%) were Shigella sonnei and 46(31.9%) were Shigella flexneri.Shigella flexneri was further classified into 6 serotypes(2a:56.8%,2c:18.9%,1a:10.8%,4c:8.1%,3a:2.7% and Y variant:2.7%).Among the 120 Shigellaisolates tested for antimicrobial susceptibility using Kirby-Bauer method, more than 95% were resistant to ampicillin,nalidixic acid,and streptomycin,88.3% to trimethoprim-sulfamethoxazole,87.5% to tetracyline,60.0% to gentamicin,49.2%to cefotaxime,24.2% to cefepime,18.3% to ceftazidime,18.3% to amoxicillin-clavulanate,16.7% to ciprofloxacin and 15.0%to ofloxacin.Overall,91.7% of the Shigellaisolates showed resistance to three or more classes of antibiotics.Conclusions Shigella sonnei is the most frequently isolated Shigella species.Shigella flexneri 2a is the most prevalent serotype followed by 2c serotype.Resistance to the clinically important antibiotics is high among Shigellaspecies in Shanghai.Ongoing local monitoring of shigellosis and other bacterial diarrhea should be enhanced.Effective empiric antibiotic therapy for shigellosis should be based on local antimicrobial susceptibility data.更多还原