目的 建立区域性网络实验室监测和分析肠炎沙门菌的耐药特征变化为科学防治提供参考依据。 方法 2006-2012年,上海市8个区域公共卫生实验室和24家临床实验室依据标化方法分离184株肠炎沙门菌食源环境菌株与1146株肠炎沙门菌腹泻病例菌株,使用纸片扩散法(K-B法)检测菌株对16种抗生素的耐药性,应用WHONET软件建立耐药数据库。 结果 历年中肠炎沙门菌在禽肉中污染率最高(155/184);实验室诊断病例主要分布在5岁以下和18~59岁、1~4岁病例明显高于1岁以下、60岁以上病例呈逐年上升趋势。所有肠炎沙门菌对萘啶酸耐药率均超过90%;多重耐药株(对氨苄西林-氯霉素-链霉素-磺胺异噁唑-四环素耐药型,ACSSuT)存在于鸡肉和2009年的1例食物中毒暴发病例中;耐头孢吡肟食源和腹泻株分别出现在2011年和2008年;腹泻株对环丙沙星和头孢噻肟的耐药率高于食源株;低年龄组病例对三代头孢和环丙沙星耐药的菌株分别约占2/3和1/2。 结论 上海市肠炎沙门菌腹泻病例存在社区内获得和食源性感染等不同因素,肠炎沙门菌多重耐药型ACSSuT可能是潜在的高致病性流行株。提高临床实验室常规诊断能力,优化和减少老年人和婴幼儿对抗生素暴露,重视多重耐药菌株导致的疾病负担。
Objective The establishment of a laboratory network surveillance system and analyze the antibiotic resistance characteristics of Salmonella enteritidis, and provide scientific evidence for the prevention and control measures development. Methods A total of 184 foodborne and environmental strains and 1146 diarrhea strains of Salmonella enteritidis were isolated in 8 public health laboratories and 24 clinical laboratories from 2006 to 2012, their drug resistance to 16 antibiotics were detected by using disk diffusion method (K-B method) and the drug resistance database was established with WHONET software. Results The detection rate of Salmonella enteritidis in poultry meat was highest (155/184). The laboratory confirmed cases were mainly distributed in people aged 18-59 years and 60 years increased gradually. The resistant rate of all Salmonella enteritidis strains to nalidixic acid was over 90%. The multidrug-resistant strains (to ampicillin, chloramphenicol, streptomycin, sulfamethoxazole and tetracycline) were isolated from chicken meat samples and 1 foodborne sample (in 2009), while foodborne strains and diarrhea strains resistant to cefepime were detected in 2011 and 2008 respectively. The resistant rates of diarrhea strains resistant to ciprofloxacin and cefotaxime were higher than those of foodborne strains. The strains resistant to the third generation cephalosporins and ciprofloxacin in lower age group accounted for approximately 2/3 and 1/2 of the total. Conclusion Community acquired and foodborne infections of Salmonella enteritidis were detected in Changning district. The multidrug resistant strains detected in Changning were probably highly pathogenic. It is important to improve laboratory's routine detection capacity, reduce the elderly and children's unnecessary antibiotic exposure for the mitigation of disease burden caused by Salmonella enteritidis infection.