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目的:分析单中心儿童肠道感染非伤寒沙门菌及志贺菌的菌群分布状态及药敏动态变化情况,指导临床用药。方法:对2010年1月至2014年12月我院肠道门诊接受诊治的肠道感染患儿留取大便标本进行分离和培养,对分离出的菌株进行鉴定及药敏试验。结果:在送检的2 119份大便标本中共培养检出415例非伤寒沙门菌和志贺菌,总检出率为19.58%(415/2 119)。在415例阳性标本中有374例非伤寒沙门菌,占90.12%,41例志贺菌,占9.88%。非伤寒沙门菌包括鼠伤寒沙门菌110例(29.41%),肠炎沙门菌106例(28.34%),其他种沙门菌属158例(42.25%)。志贺菌包括宋内志贺菌28例(68.29%),福氏志贺菌11例(26.83%),痢疾志贺菌2例(4.88%),未发现鲍曼志贺菌。非伤寒沙门菌药物敏感显示其对磷霉素耐药率最低3.0%[95%CI(1.5%,5.6%)],而对氨苄西林耐药率最高69.8%[95%CI(64.8%,74.4%)];在2010年1月至2014年12月期间对头孢曲松钠耐药率增加,对复方磺胺甲唑和氯霉素的敏感性增加。志贺菌药物敏感显示其对磷霉素耐药率最低2.6%[95%CI(0.1%,15.1%)],而对氨苄西林耐药率最高100%[95%CI(89.3%,100%)]。结论:上海地区肠道门诊患儿大便培养以鼠伤寒沙门菌、肠炎沙门菌和宋内志贺菌检出率较高。近年来该地区非伤寒沙门菌和志贺菌对氨苄西林和头孢曲松耐药率增加,而对磷霉素的敏感性较高。
OBJECTIVE: To analyze the distribution of bacteria and susceptibility to non-typhoid Salmonella and Shigella in single-center children with enteric infections and to guide the clinical use. Methods: From January 2010 to December 2014 in our hospital intestinal clinics for diagnosis and treatment of intestinal infections in children stool samples were isolated and cultured, isolates were identified and susceptibility testing. Results: A total of 415 cases of non-typhoid Salmonella and Shigella were co-cultured in a total of 2 119 stool samples. The total detection rate was 19.58% (415/2 119). There were 374 non-typhoid Salmonella in 415 positive samples, accounting for 90.12% and 41 Shigella, accounting for 9.88%. Salmonella typhimurium included 110 cases (29.41%) of Salmonella typhimurium, 106 cases (28.34%) of Salmonella enteritidis and 158 cases (42.25%) of other Salmonella species. Shigella included 28 cases of Shigella sonnei (68.29%), Shigella flexneri in 11 cases (26.83%) and Shigella dysenteriae in 2 cases (4.88%). No Shigella sonnei was found. Drug susceptibility to non-typhoid Salmonella showed a minimum of 3.0% [95% CI (1.5%, 5.6%]] for resistance to fosfomycin while the highest rate of resistance to ampicillin was 69.8% [95% CI (64.8%, 74.4 %)]; An increase in the rate of resistance to ceftriaxone sodium between January 2010 and December 2014 and an increase in susceptibility to compound sulfamethoxazole and chloramphenicol. The drug sensitivity of Shigella showed its lowest rate of resistance to fosfomycin was 2.6% [95% CI (0.1%, 15.1%)], while the rate of resistance to ampicillin was 100% [95% CI (89.3% )]. CONCLUSIONS: The detection rates of Salmonella typhimurium, Salmonella enteritidis and Shigella flexneri in stool cultures of intestinal clinics in Shanghai area are higher. In recent years, non-typhoid Salmonella and Shigella have increased the resistance rate to ampicillin and ceftriaxone in the area, but have higher sensitivity to fosfomycin.