2009-2013年我国16省市社区获得性细菌性腹泻病原菌分布及临床耐药分析

摘要

Objective To analyze the characteristics of the community-acquired bacterial diarrheal pathogen spectrum and drug resistance in China during 5 years. Methods The strains isolated from the stool samples of patients with community-acquired bacterial diarrhea were collected from 16 provinces or cities in China during 2009-2013. The bacteria were incubated with Salmo-nella, Shigella agar, gentamicin agar and MacConkey agar plate and identification of pathogens suspected to be the cause of diarrhea was performed by VITEKⅡinstrument and biochemical reaction trace coding tube. Then, Salmonella, Shigella, Vibrio and diarrhea-genic Escherichia coli were serotyped by serum agglutination test. K-B method was used for antimicrobial susceptibility testing of bacterial pathogens. Results A total of 10 881 strains of diarrheal pathogens, including 7 genus, 22 species and 90 serotypes were isolated from diarrheal patients from 16 provinces or cities in China during 5 years. There were 7632 (70.14%) strains of Shigella, 1351 (12.42%) strains of Vibrio, 981 (9.02%) strains of Salmonella , 341 (3.13%) strains of diarrheagenic Escherichia coli, 302 (2.78%) strains of Aeromonas, 269 (2.47%) strains of Plesiomonas, and 5 (0.05%) strains of Yersinia enterocolitica. The major serotypes of Shigella were F2a, F4a and F1a belonging to group B and the major serotypes of Salmonella were Salmonella enteritidis and Salmonella typhimurium. Drug sensitivity monitoring showed that Shigella had better sensitivity to cefotaxime, cefepime, cefmetazole, imipenem and fosfomycin, with the sensitivity rates of 89.7%, 92.3%, 96.7%, 100%and 97.7%; the sensitive rates of Salmonella to cefotaxime, cefepime, aztreonam, imipenem and fosfomycin were 94.0%, 97.9%, 94.4%, 100% and 96.4%; the sensitive rates of Aeromonas to cefepime, levofloxacin, imipenem and fosfomycin were 80.9%, 80.0%, 92.6% and 84.0%; diarrheagenic Escherichia coli had poor sensitivity to antibiotics generally; Vibrio had good sensitivity to antibiotics excluding ampicillin. Conclusions Shigella, Vibrio and Salmonella are the major community-acquired bacterial diarrheal pathogens in China. Empiric antibiotic therapy should be directed against these pathogens, and targeted therapy should take the results of drug sensitivity testing into consideration.%目的：分析我国近5年社区获得性细菌性腹泻病原菌分布及耐药特点。方法收集2009-2013年我国16省市分离自社区获得性细菌性腹泻患者新鲜大便标本的病原菌，用沙门、志贺菌属琼脂培养基、麦康凯培养基和庆大霉素培养基分离培养，挑取疑似腹泻病原菌的纯菌落用VITEKⅡ细菌鉴定仪和微量编码生化反应管鉴定，再以沙门菌、志贺菌、弧菌和致泻性大肠埃希菌血清凝集试验进行血清型分型；采用K-B法检测细菌的药物敏感性（药敏）。结果5年间共收集到我国16个省市各类腹泻病原菌10881株，包括7个菌属、22个菌种和90个血清型，其中志贺菌7632株（70.14%），弧菌1351株（12.42%），沙门菌981株（9.02%），致泻性大肠埃希菌341株（3.13%），气单胞菌302株（2.78%），邻单胞菌269株（2.47%），小肠结肠耶尔森菌5株（0.05%）。志贺菌血清型以B群中的F2a、F4a和F1a为主，沙门菌血清型以肠炎沙门菌和鼠伤寒沙门菌为主。药敏监测显示，志贺菌对头孢噻肟、头孢吡肟、头孢美唑、亚胺培南和磷霉素等敏感性较好，敏感率分别为89.7%、92.3%、96.7%、100%和97.7%；沙门菌对头孢噻肟、头孢吡肟、氨曲南、亚胺培南和磷霉素等敏感率分别为94.0%、97.9%、94.4%、100%和96.4%；气单胞菌对头孢吡肟、左氧氟沙星、亚胺培南和磷霉素等敏感率分别为80.9%、80.0%、92.6%和84.0%；致泄性大肠埃希菌对抗生素的敏感率普遍较差；弧菌对所测抗生素敏感性（氨苄西林除外）均较好。结论我国社区获得性细菌性腹泻病原菌以志贺菌属、弧菌属和沙门菌属为主，经验性抗生素治疗应该覆盖这些病原，靶向治疗应该考虑药敏试验结果。