目的 调查志贺菌在杭州市萧山区儿童腹泻患者中流行的主要血清型分布和耐药变迁,为临床治疗和预防提供参考依据。 方法 对2006年1月至2011年12月浙江萧山医院临床分离自腹泻儿童志贺菌菌株,进行生化鉴定、血清学分型和抗生素敏感性试验,所有数据用WHONET 5.6软件进行回顾性分析。 结果 318株志贺菌中221株(69.5%)为宋内志贺菌, 96株(30.2%)为福氏志贺菌, 鲍氏志贺菌1株(0.3%);200株(62.9%)分离自年龄组为5岁的婴幼儿;志贺菌对氨苄西林的耐药率最高达97.1%,对复方新诺明耐药率达88.8%,头孢噻肟耐药率为44.7%,未检出头孢哌酮/舒巴坦、亚胺培南和美罗培南耐药株,福氏志贺菌对环丙沙星和左旋氧氟沙星耐药率为44.8%和33.3%,而宋内志贺菌未检出氟喹诺酮类耐药株;福氏志贺菌和宋内志贺菌耐药率在哌拉西林、头孢他啶、头孢吡肟、复方新诺明和氟喹诺酮间差异有统计学意义(P0.01)。 结论 杭州市萧山区腹泻儿童志贺菌感染以宋内志贺菌为主,青霉素类和复方新诺明耐药率很高已不适合临床使用,含酶抑制剂抗生素是治疗志贺菌感染的首选药物,哌拉西林、头孢噻肟、环丙沙星和左旋氧氟沙星表现出耐药率上升趋势。
Objective To investigate the major serotypes and drug resistance of Shigella isolated from sick children with diarrhea in Xiaoshan, Zhejiang province, and provide evidence for rational use of antibiotics and diarrhea prevention. Methods The biochemical identification, serotyping and drug susceptibility test were conducted for the strains of Shigella isolated from diarrhea children in our hospital from January 2006 to December 2011, and the data were analyzed with WHONET 5.6 Software. Results Among 318 strains of Shigella isolated, 221 were Shigella sonnei (69.5%), 96 were Shigella flexneri (30.2%), only 1 was Shigella boydii (0.3%). Totally 200 strains (62.9%) were detected in age group 5years, the resistance rate to ampicillin was highest (97.1%),followed by trimethoprim-sulfamethoxazole (TMP/SMZ) (88.8%) and cefotaxim (44.7%). No strain was detected to be resistant to cefoperazone/sulbactam, imipenem and meropenem. The resistance rates of Shigella flexneri to ciprofloxacin and levofloxacin were 44.8% and 33.3%,but no Shigella sonnei strain was detected to be resistant to fluoroquinolones. The differences in the resistance rates to piperacillin, ceftazidime, cefepime, TMP/SMZ and fluoroquinolones between Shigella flexneri and Shigella sonnei had statistical significance (P0.01). Conclusion The major pathogen to cause diarrhea in children was Shigella sonnei in Xiaoshan, Penicillin and TMP/SMZ are not suitable for the clinical treatment. Enzyme inhibitors is the first choice for the treatment of Shigella infection. The resistant rate of Shigella to piperacillin, cefotaxime, ciprofloxacin and levofloxacin showed an upward trend.