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目的分析2012―2014年珠海市哨点医院腹泻病例沙门菌的血清型分布和耐药情况。方法在珠海市2家哨点监测医院中选择以腹泻症状为主诉的门诊病例,采集病例粪便样本进行沙门菌分离培养、生化鉴定和血清学分型,采用药敏纸片法(K-B法)进行12种抗生素的药敏试验。结果分离培养共获得沙门菌535株,分成46种血清型,常见血清型分别为Ⅰ4,5,12∶i∶-、鼠伤寒沙门菌、肠炎沙门菌和斯坦利沙门菌,共占检出菌株总数的74.8%(400/535)。535株菌株耐药率较高的抗生素有磺胺复合物、氨苄西林、四环素、链霉素、萘啶酮酸,耐药率分别为84.3%、62.8%、61.7%、56.4%和50.7%;较为敏感的抗生素是三代或四代头孢类抗生素头孢噻肟、头孢他啶和头孢吡肟,耐药率分别为6.5%、4.1%和5.4%。535株沙门菌的多重耐药率为69.9%,其中多重耐药谱为ASSu T+(同时对氨苄西林、链霉素、磺胺类和四环素4种或更多种抗生素耐药)的占64.2%(240/374)。沙门菌Ⅰ4,5,12∶i∶-和鼠伤寒沙门菌的多重耐药情况最为严重,多重耐药率分别为96.9%(155/160)和97.8%(87/89)。结论珠海市腹泻病例沙门菌常见血清型为Ⅰ4,5,12∶i∶-和鼠伤寒沙门菌,沙门菌多重耐药情况较为严重,但对三、四代头孢类抗生素较为敏感,可作为临床治疗沙门菌感染首选用药。
Objective To analyze the serotype distribution and drug resistance of Salmonella in patients with diarrhea in Zhuhai Sentinel Hospital from 2012 to 2014. Methods Outpatients were selected from two sentinel surveillance hospitals in Zhuhai City for the diagnosis of diarrhea. Samples of stool samples were collected for isolation, culture, biochemical identification and serological typing of Salmonella. KB method was used for 12 Antibiotic susceptibility testing. Results 535 strains of Salmonella were isolated and cultured, which were divided into 46 serotypes. The common serotypes were Salmonella typhimurium, Salmonella Enteritidis and Salmonella typhimurium, 74.8% (400/535) of the total. Among the 535 strains, the antibiotics with higher drug resistance rates were 84.3%, 62.8%, 61.7%, 56.4% and 50.7%, respectively, with sulfonamides, ampicillin, tetracycline, streptomycin and nalidixic acid The sensitive antibiotics were cefotaxime, ceftazidime and cefepime, which were third- or fourth-generation cephalosporins with resistance rates of 6.5%, 4.1% and 5.4% respectively. The multi-drug resistance rate of 535 strains of Salmonella was 69.9%, of which multiplex resistance spectrum was 64.2% with ASSu T + (resistant to ampicillin, streptomycin, sulfonamides and tetracycline, four or more antibiotics) 240/374). The multi-drug resistance of Salmonella I4, 5, 12:i:- and Salmonella typhimurium were the most serious, and the multi-drug resistance rates were 96.9% (155/160) and 97.8% (87/89) respectively. Conclusions The common serotypes of Salmonella in Zhuhai diarrhea cases are Ⅰ 4, 5, 12:i:- and S. typhimurium. The multi-drug resistance of Salmonella is more serious, but it is sensitive to the third- and fourth-generation cephalosporin antibiotics and can be used as clinical Salmonella treatment of choice medication.