2021年安徽省阜阳市一起感染性腹泻暴发疫情的病原菌溯源分析

郭国侠; 孟昭倩; 高夏莲; 段然; 郭靓子; 卜戈

doi:10.3784/jbjc.202303030077

2021年安徽省阜阳市一起感染性腹泻暴发疫情的病原菌溯源分析

doi: 10.3784/jbjc.202303030077

1.
阜阳市疾病预防控制中心, 安徽阜阳 236030
2.
中国疾病预防控制中心传染病预防控制所, 北京 102206

基金项目: 安徽省医疗卫生重点专科建设项目，阜阳市卫生健康委员会科研立项课题（No. FY2019079）

详细信息

作者简介:
郭国侠，女，安徽省阜南县人，副主任技师，主要从事病原微生物检测工作，Email：731868074@qq.com

通讯作者:
卜戈，Tel：0558–2560321，Email：865202817@qq.com

中图分类号: R211；R516.3
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出版历程
- 收稿日期: 2023-03-03
- 网络出版日期: 2023-07-27

Infection source of an infectious diarrhea epidemic in Fuyang, Anhui province in 2021

1.
Fuyang Prefectural Center for Disease Control and Prevention, Fuyang 236030, Anhui, China
2.
Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China

Funds: This study was supported by the fund of Medical and Health Key Specialty Construction Project of Anhui Province; Scientific Research Project of Fuyang Municipal Health Commission (No. FY2019079)

More Information

Corresponding author: Bu Ge, Email: 865202817@qq.com

摘要

摘要: 目的对2021年安徽省阜阳市某集中供餐学校发生的一起感染性腹泻暴发疫情进行病原学检测及溯源分析，为疫情处置和控制提供科学依据。方法根据流行病学特征，采集患者肛拭子、粪便、呕吐物和食堂留样食品等进行病原体检测。对分离出的细菌进行鉴定、药敏试验、毒力基因检测、脉冲场凝胶电泳（PFGE）和全基因序列分析。结果从患者和留样食品中分离出19株肠炎沙门菌，均携带毒力基因（invA、sopE、agfA、spvR、hilA、stn、pefA）。 19株肠炎沙门菌对萘啶酸均耐药，18株菌对氨苄西林、四环素、头孢噻肟、头孢他啶、氨苄西林/舒巴坦和链霉素耐药。全基因组测序的6株肠炎沙门菌均检测出7种获得性耐药基因和1个靶基因位点突变，分别为aac(6')-Iy、aph(3'')-Ib、aph(6)-Id、bla_TEM-1B、aac(6')-Iaa、sul2、tet(A)和gyrA (p.D87Y)。 19株肠炎沙门菌的PFGE带型相似度是100%，均为ST11型。结论引起此次感染性腹泻暴发的病原体为肠炎沙门菌，感染来源为金丝脆鸡排。分离菌株对青霉素和头孢菌素高度耐药，耐药机制与携带bla_TEM-1B相关。
- 肠炎沙门菌 /
- 药物敏感性 /
- 毒力基因 /
- 脉冲场凝胶电泳 /
- 全基因组测序
Abstract: Objective To identify the pathogen and infection source of an infectious diarrhea epidemic in a school in Fuyang, Anhui province, in 2021, and provide scientific evidence for the epidemic management and control. Methods According to the epidemiological characteristics, the anal swabs, stool samples and vomit samples from the cases and food samples from the canteen were collected for the detection of pathogens. The strain identification, drug susceptibility test, virulence gene detection, pulsed-field gel electrophoresis (PFGE) and whole genome sequence analysis were conducted. Results A total of 19 strains of Salmonella Enteritidis were isolated from the cases and food samples, all carried virulence genes (invA, sopE, agfA, spvR, hilA, stn, pefA). All the S. Enteritidis strains were resistant to nalidixic acid, 18 strains were resistant to ampicillin, tetracycline, cefotaxime, ceftazidime, ampicillin/sulbactam, and streptomycin and 7 acquired resistance genes and 1 target gene mutation were detected in 6 strains of S. Enteritidis, including aac (6')-Iy, aph (3)-Ib, aph (6)-Id, bla_TEM-1B, aac (6')-Iaa, sul2, tet (A) and gyrA (p.D87Y). The PFGE pattern bands of 19 strains of S. Enteritidis showed 100% similarity, all were ST11. Conclusion The pathogen causing the epidemic of infectious diarrhea was S. Enteritidis, and the isolated strains showed high resistance to penicillin and cephalosporin. The infection source was dish golden crispy chicken chops. The mechanism of drug resistance was related to the carriage of bla_TEM-1B.
- Salmonella Enteritidis /
- Drug sensitive /
- Virulence genes /
- Pulsed-field gel electrophoresis /
- Whole genome sequencing.

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表 1 用于扩增沙门菌毒力基因的引物

Table 1. Primers used to amplify virulence genes of Salmonella

基因	引物序列（5′～3′）	毒力决定簇	扩增产物长度（bp）	退火温度（℃）
invA	F:GTGAAATTATCGCCACGTTCGGGCAA	SPI1	284	55
	R:TCATCGCACCGTCAAAGGAACC
sopE	F:CAGACCCGTGAAGCTATACT	SPI1	380	55
	R: AATTGCTGTGGAGTCGGCAT
agfA	F: GGATTCCACGTTGAGCATTT	编码菌毛基因	312	55
	R: GTTGTTGCCAAAACCAACCT
spvR	F: CAGGTTCCTTCAGTATCGCA	毒力质粒	310	55
	R: TTTGGCCGGAAATGGTCAGT
hilA	F: TTAACATGTCGCCAAACAGC	SPI1	216	55
	R: GCAAACTCCCGACGATGTAT
stn	F: GAAGCAGCGCCTGTAAAATC	编码肠毒素基因	405	55
	R: GCTGACTCAGGTGCTGTTGA
pefA	F: ACACGCTGCCAATGAAGTGA	毒力质粒	450	55
	R: ACTGCGAAAGATGCCACAGA
注：F. 正向引物；R. 反向引物

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表 2 48份样品中肠炎沙门菌的检出情况

Table 2. Detection of Salmonella enteritidis in 48 samples

样本	样本数（份）	肠炎沙门菌阳性数（份）	阳性率（%）
患者肛拭子	18	15	83.33
患者粪便	1	1	100.00
患者呕吐物	6	1	16.67
后厨肛拭子	3	0	0.00
留样食品	8	2	25.00
食堂厨（餐）具涂抹物	8	0	0.00
生鸡蛋涂抹物	3	0	0.00
食堂用水	1	0	0.00
合计	48	19	39.58

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