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目的了解宁波地区腹泻患者病原菌构成和耐药性,为防控感染性腹泻提供依据。方法病原菌检测采用直接分离与增菌分离相结合的方法;细菌筛检和鉴定采用生化和生化鉴定试剂条API等法,鉴定到种、群;病原菌血清分型采用血清凝集法;药敏试验采用K-B法;耐药基因检测采用PCR法,统计学分析采用SPSS 11.0软件包进行,率的比较采用χ2检验和F分析。结果 9 256份标本中检出8类16种3 473株病原菌,检出率为37.52%,其中,副溶血性弧菌、沙门菌和气单胞菌的检出率分别为16.13%(1 493/9 256)、3.99%(369/9 256)和3.44%(318/9 256),副溶血性弧菌的检出率明显高于其他病原菌(χ2=21.68,P<0.01);血清分型发现副溶血性弧菌的O3群(349/480)、沙门菌的甲型副伤寒菌(168/369)、志贺菌的褔氏志贺菌(117/175)、致病性大肠埃希菌O119(28/66)为各病原菌的优势菌,检出了褔氏1C、2C和4C志贺菌新亚型;药敏试验显示病原菌对大多数抗生素敏感,但有45株为多重耐药菌,其中气单胞菌23株、志贺菌8株、致泻性大肠埃希菌8株、金黄色葡萄球菌3株、变形杆菌2株、沙门菌1株,占总菌数的2.45%,检出了bla-TEM、sull和aacc等3种耐药基因。结论宁波地区感染性腹泻病原构成复杂,副溶血性弧菌是最主要的流行病原菌;检出褔氏C型志贺菌提示其血清型可能或正在转换,需加强对志贺菌变迁的监测,以预防疾病的暴发;致病性不强的气单胞菌和类志贺邻单胞菌检出率较高,应引起关注;耐药菌株中有2.45%的病原菌为超广谱β-内酰胺酶(ESBL)菌株,涉及多个菌属,提示临床治疗中合理用药是减少耐药菌的传播和扩散的关键。
Objective To understand the constitution and drug resistance of pathogens in patients with diarrhea in Ningbo and to provide basis for prevention and control of infectious diarrhea. Methods The method of direct separation and enrichment separation was used to detect pathogenic bacteria. The bacteria were screened and identified by biochemical and biochemical identification reagent strips API and other methods to identify species and groups. Serological typing of pathogens was determined by serum agglutination method. KB method; drug resistance gene detection using PCR method, statistical analysis using SPSS 11.0 software package, the rate of comparison using χ2 test and F analysis. Results The results showed that the detection rate of 16 strains (16.13%) was 16.13% (1343%) among the 9 256 strains of 8 strains and 3 473 strains of pathogens, the detection rate was 37.52%. Among them, the detection rates of Vibrio parahaemolyticus, Salmonella and Aeromonas were 16.13% 936), 3.99% (369/9 256) and 3.44% (318/9 256) respectively. The detection rate of Vibrio parahaemolyticus was significantly higher than that of other pathogens (χ2 = 21.68, P <0.01) O3 group (349/480) of Vibrio parahaemolyticus, Salmonella paratyphi A (168/369) of Salmonella, Shigella spp. (117/175) of Shigella, pathogenic Escherichia coli O119 (28/66) was the predominant bacteria of each pathogen, and the new subtype of Shigella spp. 1C, 2C and 4C was detected. The susceptibility test showed that the pathogen was sensitive to most antibiotics, but 45 strains were multi-drug resistant Including 23 strains of Aeromonas, 8 strains of Shigella, 8 strains of diarrhea-causing Escherichia coli, 3 strains of Staphylococcus aureus, 2 strains of Proteus and 1 strain of Salmonella, accounting for 2.45% of the total number of bacteria, Three kinds of resistance genes such as bla-TEM, sull and aacc were detected. Conclusions The pathogen of infectious diarrhea in Ningbo is complex and Vibrio parahaemolyticus is the most important epidemic pathogen. Shigella flexneri C type is detected, indicating that its serotype may or may not be changing. Monitoring of Shigella flexneri should be strengthened, To prevent the outbreak of disease; the less pathogenic Amycolatopsis and Shigella spp. Detection rate should be cause for concern; 2.45% of the resistant strains of pathogenic bacteria for extended-spectrum β-endo Amylolytic enzyme (ESBL) strains, involving multiple bacteria, suggesting that the rational use of clinical treatment is to reduce the spread of drug-resistant bacteria and proliferation of the key.