桑灏, 崔燕, 顾文超, 孔令娜, 王瑞, 蒋潇丽, 王庆荟. 2015-2018年上海市儿童腹泻流行特征及致泻性大肠埃希菌耐药分析[J]. 疾病监测, 2019, 34(6): 559-564. DOI: 10.3784/j.issn.1003-9961.2019.06.019
引用本文: 桑灏, 崔燕, 顾文超, 孔令娜, 王瑞, 蒋潇丽, 王庆荟. 2015-2018年上海市儿童腹泻流行特征及致泻性大肠埃希菌耐药分析[J]. 疾病监测, 2019, 34(6): 559-564. DOI: 10.3784/j.issn.1003-9961.2019.06.019
Hao Sang, Yan Cui, Wenchao Gu, Lingna Kong, Rui Wang, Xiaoli Jiang, Qinghui Wang. Epidemiological characteristics of diarrhea in children and drug resistance of diarrheagenic Escherichia coli in Shanghai, 2015–2018[J]. Disease Surveillance, 2019, 34(6): 559-564. DOI: 10.3784/j.issn.1003-9961.2019.06.019
Citation: Hao Sang, Yan Cui, Wenchao Gu, Lingna Kong, Rui Wang, Xiaoli Jiang, Qinghui Wang. Epidemiological characteristics of diarrhea in children and drug resistance of diarrheagenic Escherichia coli in Shanghai, 2015–2018[J]. Disease Surveillance, 2019, 34(6): 559-564. DOI: 10.3784/j.issn.1003-9961.2019.06.019

2015-2018年上海市儿童腹泻流行特征及致泻性大肠埃希菌耐药分析

Epidemiological characteristics of diarrhea in children and drug resistance of diarrheagenic Escherichia coli in Shanghai, 2015–2018

  • 摘要:
    目的了解上海市儿童腹泻流行特征、病原谱及致泻性大肠埃希菌(DEC)的耐药情况。
    方法收集2015年4月至2018年3月在监测点医院就诊的初诊儿童腹泻病例临床及流行病学资料,同时采集粪便标本进行细菌培养及病毒核酸检测,对分离的DEC进行耐药分析。
    结果共收集儿童腹泻病例880例,以<5岁幼儿为主(92.95%)。 儿童腹泻病例病原检出率为47.50%,且男女性之间差异无统计学意义(χ2=1.778,P=0.182);0 ~ 1岁组病原检出率显著低于其他各年龄组(χ2=90.929,P<0.001);非母乳喂养儿、混合喂养儿的病原检出率均高于纯母乳喂养儿(χ2=31.384、14.746,均P<0.001);托幼儿童病原检出率高于散居儿童(χ2=11.158,P=0.001)。 单一病原体的检出,细菌以沙门菌(5.11%)、肠致病性大肠埃希菌(4.55%)、空肠弯曲菌(4.43%)、肠集聚性黏附大肠埃希菌(3.07%)为主;病毒以诺如病毒GⅡ型(7.95%)和轮状病毒A组(4.66%)为主。 单纯细菌在≥5岁组检出率最高(35.48%);单纯病毒在3 ~ 4岁组检出率最高(28.30%);细菌混合病毒在≥5岁组检出率最高(9.68%)。 夏季以细菌为优势病原菌;秋季呈现细菌向病毒过渡状态,细菌混合病毒感染检出率处于全年高峰;冬季以病毒为优势病原。 DEC对二、三代头孢菌素头孢噻肟、头孢呋辛、头孢西丁的耐药率分别为15.44%、20.59%、5.88%;对喹诺酮类药物左氧氟沙星、环丙沙星的耐药率均为5.15%。
    结论托幼儿童病原检出率较高,需引起重视。 细菌性腹泻及病毒性腹泻呈现一定的年龄特征及季节性变化。 头孢菌素类药物耐药率低于全国水平,但仍需注意合理使用抗生素。

     

    Abstract:
    ObjectiveTo investigate the epidemiological characteristics and pathogenic spectrum of diarrhea in children in Shanghai, and analyze the drug resistance of diarrheagenic Escherichia coli (DEC).
    MethodsThe clinical and epidemiological information of the children who sought medical case in sentinel hospitals due to diarrhea from April 2015 to March 2018 were collected. The stool samples were collected from them for bacterium culture and virus nucleic acid test. The test of drug resistance of the DEC strains was conducted.
    ResultsA total of 880 children with diarrhea were surveyed, in whom 92.95% were less than 5 years old. The overall pathogen detection rate was 47.50%. There was no significant difference in pathogen detection rate between boys and girls (χ2=1.778, P=0.182). The pathogen detection rate was significantly lower in infants less than 1 year old than in other groups (χ2=90.929, P<0.001). The pathogen detection rate was significantly lower in breastfed infants than in non-breastfed infants and mixed feeding infants (χ2=31.384, 14.746, P<0.001). The pathogen detection rate was higher in children in child care settings than in children outside child care settings (χ2=11.158, P=0.001). The common bacteria causing diarrhea was Salmonella (5.11%), followed by enteropathogenic E. coli (4.55%), Campylobacter jejuni (4.43%) and enteroaggregative E. coli (3.07%). The common viruses detected were Norovirus GⅡ(7.95%) and rotavirus A (4.66%). The bacteria detection rate was highest in children over 5 years old (35.48%). The virus detection rate was highest in children aged 3–4 years (28.30%). The co-infection rate of bacteria and virus was highest in children aged ≥5 years (9.68%). The predominant pathogen was bacterium in summer and virus in winter. The peak of the detection of co-infection of bacterium and virus was in autumn. The drug resistance rates of DEC to second and third generation cephalosporins of cefotaxime, cefuroxime, cefoxitin were 15.44%, 20.59% and 5.88%, respectively. The drug resistance rates of DEC to quinolones of levofloxacin and ciprofloxacin were all 5.15%.
    ConclusionClose attention should be paid to children in child care settings since the pathogen detection rate was considerably high. The incidences of bacterial diarrhea and viral diarrhea showed obvious age and seasonal patterns. Although the drug resistance level of DEC to second and third generation cephalosporins was lower than the national level, it is still necessary to use antibiotics rationally.

     

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