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目的了解北京市丰台区感染性腹泻致病菌的病原构成、流行特征及病原菌耐药情况,监测病原谱变迁趋势,为本地区细菌性腹泻防治提供依据。方法收集2010-2012年4-10月丰台区4家哨点医院肠道门诊腹泻患者的粪便标本,按照中华人民共和国卫生行业标准WS 287-2008、WS 271-2007和WS 289-2008进行沙门菌、志贺菌、副溶血性弧菌、霍乱弧菌、致泻性大肠埃希菌等常见肠道致病菌检测,并对病原菌的时间分布、人群分布、血清型别构成进行统计学分析,按美国CLSI(临床实验室标准化协会)推荐的纸片扩散法对近期分离的140株致病菌做了药敏测定。结果从收集到的1108份标本中共分离到357株致病菌,阳性率为32.22%。阳性菌中居首位的是副溶血性弧菌,占50.98%,其次为沙门菌,占18.49%。病原菌的检出具有明显的季节性,7-9月是高峰。不同年龄组之间检出率的差异有统计学意义(P<0.05),副溶血性弧菌在不同性别间检出率差异有统计学意义(P<0.01)。检出的副溶血性弧菌、志贺菌和沙门菌的优势血清型分别为O3K6型副溶血性弧菌、宋内志贺菌、山夫登堡沙门菌和肠炎沙门菌。各种病原菌对抗菌药物的敏感性不同,多数检出菌对头孢西丁、阿莫西林-克拉维酸、氨曲南敏感性较高。结论丰台区细菌性腹泻病原菌主要以副溶血性弧菌和沙门菌为主,病原谱已发生变迁,各种病原菌耐药性不同,应加强主动监测。
Objective To understand the pathogenic constitution, epidemiological characteristics and pathogens resistance of infectious diarrhea pathogens in Fengtai District of Beijing and to monitor the trend of pathogen spectrum changes, so as to provide basis for the prevention and treatment of bacterial diarrhea in this area. Methods Stool samples of diarrhea patients from four sentinel hospitals in Fengtai District from April to October in 2010-2012 were collected and analyzed according to Health Industry Standards WS 287-2008, WS 271-2007 and WS 289-2008 of the People’s Republic of China , Shigella, Vibrio parahaemolyticus, Vibrio cholerae, diarrheal Escherichia coli and other common intestinal pathogenic bacteria were detected, and the time distribution of the pathogenic bacteria, population distribution, the type of serum composition for statistical analysis, According to the paper diffusion method recommended by the CLSI (Clinical Laboratory Standards Institute) of the United States, 140 drug-resistant strains isolated recently were tested. Results A total of 357 pathogenic bacteria were isolated from 1108 collected samples, the positive rate was 32.22%. Positive bacteria in the first place is Vibrio parahaemolyticus, accounting for 50.98%, followed by Salmonella, accounting for 18.49%. Pathogen detection has obvious seasonal, July-September is the peak. There were significant differences in the detection rates among different age groups (P <0.05). The detection rate of Vibrio parahaemolyticus between different sexes was statistically significant (P <0.01). The dominant serotypes of Vibrio parahaemolyticus, Shigella spp. And Salmonella spp. Were Vibrio parahaemolyticus type O3K6, Shigella sonnei, Salmonella scophthalm and Salmonella enteritidis. The sensitivity of various pathogenic bacteria to antibiotics is different, and most of the tested bacteria are highly sensitive to cefoxitin, amoxicillin-clavulanic acid and aztreonam. Conclusion The main pathogens of bacterial diarrhea in Fengtai District are Vibrio parahaemolyticus and Salmonella, the pathogen spectrum has changed, and the pathogenic bacteria have different drug resistance. Therefore, active surveillance should be strengthened.