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[目的]研究基于公共卫生实验室主动监测哨点医院沙门菌腹泻及优势菌型的耐药性和分子型特征。[方法]选择辖区内2家医院作为主动监测哨点,甄别食源性感染性腹泻的病例并采集粪便标本进行沙门菌培养、血清型鉴定和抗菌药物耐药性试验,通过脉冲场凝胶电泳(PFGE)分析优势菌型的遗传同源性。[结果]2010—2012年,共检测2 579份标本,分离沙门菌185株(年度阳性率分别为9.1%、6.8%、5.1%,总阳性率为7.2%),涵盖23种不同血清型,最常见的为肠炎和鼠伤寒沙门菌。所有沙门菌感染病例的男女性别比为0.9∶1;肠炎和鼠伤寒沙门菌感染均以21~60岁(68.9%)和60岁以上(21.4%)者居多。肠炎和鼠伤寒沙门菌对萘啶酸、磺胺异噁唑、链霉素、甲氧嘧啶、庆大霉素、四环素等6种抗菌药物的耐药率分别为27.7%~96.9%和2.6%~63.2%,且肠炎沙门菌的耐药率显著高于鼠伤寒沙门菌(P值均<0.05)。22株肠炎和20株鼠伤寒沙门菌经PFGE各自分为11个和6个分子型。[结论]肠炎和鼠伤寒是区域内最常见的沙门菌腹泻菌型,分子分型提示存在优势克隆的聚集性爆发和分散爆发,应警惕多重耐药的肠炎沙门菌克隆株形成潜在爆发的风险。加强以实验室为基础的主动监测对控制食源性感染性腹泻具有重要的公共卫生意义。
[Objective] To study the drug resistance and molecular characteristics of Salmonella diarrhea and dominant bacteria based on the public health laboratory’s initiative to monitor sentinel hospital. [Method] Two hospitals in the area were selected as active surveillance sentinel sites to screen cases of food-borne infectious diarrhea and stool samples were collected for Salmonella culture, serotype identification and antimicrobial drug resistance test. Pulsed field gel electrophoresis (PFGE) analysis of dominant bacterial genetic homology. [Results] A total of 2 579 specimens were detected and 185 strains of Salmonella were isolated from 2010 to 2012 (the annual positive rates were 9.1%, 6.8% and 5.1%, respectively, with a total positive rate of 7.2%), covering 23 different serotypes, The most common are enteritis and Salmonella typhimurium. The sex ratio for all Salmonella infections was 0.9: 1. Salmonella enteritidis and Salmonella typhimurium infections were mostly found in 21-60 years (68.9%) and older than 60 years (21.4%). Enteritidis and Salmonella typhimurium resistant rate of nalidixic acid, sulfisoxazole, streptomycin, methoxypyrimidine, gentamicin, tetracycline and other six kinds of antibacterials were 27.7% ~ 96.9% and 2.6% ~ 63.2%, and the rate of Salmonella enteritidis was significantly higher than that of Salmonella typhimurium (P <0.05). 22 enteritis and 20 Salmonella typhimurium by PFGE were divided into 11 and 6 molecular types. [Conclusion] Enteritis and typhoid fever are the most common Salmonella diarrhea strains in the region. Molecular typing suggests clustered and dispersed outbreaks of dominant clones. The risk of potential outbreaks of multi-drug resistant Salmonella enteritidis strains should be observed . Strengthening laboratory-based proactive monitoring has important public health implications for the control of food-borne infectious diarrhea.