感染性腹泻患者病原菌流行趋势及耐药性分析

摘要

目的 了解感染性腹泻患者常见病原菌的流行趋势及耐药性,为临床治疗提供科学依据.方法 对2012年4月1日-2017年10月31日本院肠道门诊12 156例感染性腹泻患者粪便标本进行增菌及分离培养,用Vitek 2 Compact全自动微生物鉴定/药敏分析系统和基质辅助激光解吸飞行时间质谱仪(MALDI-TOF MS)进行菌种鉴定,凝集试验进行血清分型,K-B纸片扩散法测定6种抗菌药物敏感性.结果 12 156份标本共培养出病原菌1 218株,致病菌总检出率为10.02％,其中弧菌属7.62％ (926/12 156)、气单胞菌属0.79％(96/12 156)、沙门菌属1.46％(178/12 156)、志贺菌属0.15％(18/12 156).2012-2017年致病菌年检出率分别为9.2％、11.9％、13.4％、7.0％、11.3％和7.2％.志贺菌属检出率维持较低水平,但其对氨苄西林、复方磺胺甲嗯唑存在较高耐药现象.其余病原菌除对氨苄西林耐药率较高外,对其余5种抗菌药物均保持较高的敏感性.结论 本院感染性腹泻患者的病原菌主要为弧菌属,耐药性最高的为志贺菌属,整体感染呈散发态势,应加强对感染性腹泻患者病原菌及耐药性的检测.%Objective To investigate the epidemic tendency and drug resistance of common pathogenic bacteria in the patients with infectious diarrhea,and then provide scientific evidence for the treatment of bacterial diarrhea.Methods The feces specimens were collected from 12 156 patients with infectious diarrhea in our hospital during April 1,2012 and October 31,2017.Then,they were cultured,and the obtained bacteria were isolated and identified by the Vitek 2 Compact system and matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF-MS).The serotype and drug resistance of the obtained bacteria were analyzed by the agglutination test and K-B disk diffnsion method,respectively.Results A total of 1 218 strains (10.02％,1 218/12 156) of pathogenic bacteria were isolated from 12 156 feces specimens,including 926 (7.62％,926/12 156) strains of Vibrio,96 (0.79％,96/12 156) strains of Aeromonas,178 (1.46％,178/12 156) strains of Salmonella and 18 (0.15％,18/12 156) strains of Shigella.The detection rates of pathogenic bacteria per year were 9.2％,11.9％,13.4％,7.0％,11.3％ and 7.2％,respectively,from 2012 to 2017.The detection rate of Shigella was low,but it had a high resistance to ampicillin and compound sulfamethoxazole (SMZ-TMP).Other pathogenic bacteria were more sensitive to SMZ-TMP,ceftriaxone,aztreonam,gentamycin and quinolones except ampicillin.Conclusion The main pathogenic bacterium in the patients with infectious diarrhea is Vibrio,and Shigella has the highest resistance to most drugs.The overall infection tendency is sporadic.It is necessary to strengthen the monitoring of pathogenic bacteria and their drug resistance in the patients with infectious diarrhea.