2013-2017年河南省婴幼儿志贺菌流行特征与耐药分析

穆玉姣; 王若琳; 张白帆; 赵嘉咏; 李孟磊; 夏胜利; 黄学勇

doi:10.16462/j.cnki.zhjbkz.2019.07.018

2013-2017年河南省婴幼儿志贺菌流行特征与耐药分析

doi: 10.16462/j.cnki.zhjbkz.2019.07.018

450016 郑州, 河南省疾病预防控制中心传染病预防控制所, 河南省医学病原生物学重点实验室

基金项目:

国家科技重大专项 2018ZX10713003-002-003

河南省医学科技攻关计划 201702271

河南省重大科技专项 182102310207

详细信息

通讯作者:
黄学勇, E-mail: hxyzz@163.com

中图分类号: R181
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出版历程
- 收稿日期: 2019-01-31
- 修回日期: 2019-04-01
- 刊出日期: 2019-07-10

Epidemiological characteristics and drug resistance surveillance of Shigella in infants and young children in Henan Province from 2013 to 2017

Institute for Communicable Disease Control and Prevention, Henan Provincial Center for Disease Prevention and Control, Henan Key Laboratory of Pathogenic Microorganisms, Zhengzhou 450016, China

Funds:

National Science and Technology Major Projects of China 2018ZX10713003-002-003

Henan medical science and technology research plan 201702271

Major science and technology special projects in Henan 182102310207

More Information

Corresponding author: HUANG Xue-yong, E-mail: regnier@ibpc.fr

摘要

摘要: 目的了解河南省2013-2017年婴幼儿志贺菌的病原学特征。方法以河南省5岁以下腹泻患儿5 149份粪便分离的606株志贺菌为研究对象，采用血清分型、药物敏感试验及聚合酶链式反应(polymerase chain reaction，PCR)检测毒力基因方法，对其进行病原学检测。结果儿童志贺菌总检出率为11.77%(606/5 149)，1~岁年龄组幼儿检出率最高，为24.08%；606株志贺菌共分为2群、11种血清型，其中福氏志贺菌占73.43%，宋内志贺菌占26.57℅。176株志贺菌对氨苄西林、萘啶酸的耐药严重(耐药率>90%)，对氯霉素、环丙沙星，诺氟沙星、复方新诺明的耐药率>65%，对亚胺培南和头孢类抗生素敏感度较高，且福氏与宋内志贺菌耐药有差异。婴幼儿毒力基因组合模式以shET-1+、shET-2+、ipaH+、ial+为主，并检出5株无毒力株。结论河南省婴幼儿细菌性痢疾以福氏志贺菌为主，对常用的抗生素存在严重的耐药问题，不同血清型菌株携带优势基因模式不同。
- 婴幼儿 /
- 志贺菌 /
- 血清型 /
- 耐药性 /
- 毒力基因 /
Abstract: Objective To investigate the pathogenic characteristics of Shigella in infants from 2013 to 2017 in Henan Province. Methods From 2013 to 2017, 606 Shigella strains were isolated from 5 149 children with diarrhea under 5 years old in Henan Province. Serotyping, drug sensitivity test and Polymerase Chain Reaction detection of virulence gene methods were used to detect the pathogen of Shigella. Results The detection rate of Shigella in children with diarrhea was 11.77%, and the highest detection rate was in the 1-2 age group(24.08%). 606 Shigella strains were divided into two groups and 11 serotypes. Shigella flexneri accounted for 73.43%, and Shigella sonnei accounted for 26.57%. Resistance of 176 Shigella strains to ampicillin and naphthidine was serious (resistance rate > 90%), and the resistance rates to chloramphenicol, ciprofloxacin, norfloxacin and compound sulfamethoxamine were higher than 65%, and the sensitivity of imipenem and cephalosporin were higher. There were differences in drug resistance between Shigella flexneri and Shigella sonnei. The virulence genes of infants were mainly shET-1+, shET-2+, ipaH+ and ial+, and 5 avirulent strains were detected. Conclusions The bacterial dysentery of infants in Henan Province is dominated by Shigella flexneri. There are serious resistance and multidrug resistance to common antibiotics, and the dominant genes in different serotyping strains are different.
- Infant /
- Shigella /
- Surveillance /
- Serotyping /
- Drug resistance /
- Virulencegenes

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图 1 不同年龄组患儿在不同月份志贺菌检出情况

Figure 1. Detection of Shigella in children of different age groups in different months

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表 1 2013-2017年腹泻患儿志贺菌检出情况

Table 1. Shigella detection in children with diarrhea from 2013 to 2017

年龄组(岁)	2013年		2014年		2015年		2016年		2017年		合计
年龄组(岁)	采样数(株)	检出菌株数(株)	采样数(株)	检出菌株数(株)	采样数(株)	检出菌株数(株)	采样数(株)	检出菌株数(株)	采样数(株)	检出菌株数(株)	采样数(株)	检出菌株数(株)
0~	382	31	353	25	345	30	486	15	386	11	1 952	112
1~	186	53	230	62	229	75	249	54	244	30	1 138	274
2~	137	22	154	30	154	36	146	8	143	19	734	115
3~	140	16	131	9	130	19	239	6	138	8	678	58
4~	127	8	135	11	126	13	132	7	127	8	647	47
合计	972	130	1 003	137	984	173	1 152	90	1 038	76	5 149	606

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表 2 2013-2017年幼儿分离株血清型(株)及构成比[n(%)]

Table 2. Serotypes (strains) and constituent ratios (%) of infant isolates[n(%)]

血清分型	2013年	2014年	2015年	2016年	2017年	合计
B群
F1a	16(12.31)	15(10.95)	18(10.40)	9(10.00)	7(9.21)	65(10.73)
F2a	80(61.54)	57(41.61)	70(40.46)	32(35.56)	44(57.89)	283(46.70)
F2b	8(6.15)	2(1.46)	2(1.16)	0(0.00)	3(3.95)	15(2.48)
F2b^*	0(0.00)	0(0.00)	3(1.73)	0(0.00)	0(0.00)	3(0.50)
F4	2(1.54)	2(1.46)	2(1.16)	1(1.11)	3(3.95)	10(1.65)
F4c	17(13.08)	13(9.49)	23(13.29)	1(1.11)	0(0.00)	54(8.91)
F6	1(0.77)	0(0.00)	0(0.00)	2(2.22)	0(0.00)	3(0.50)
Fx	0(0.00)	1(0.73)	4(2.31)	2(2.22)	1(1.32)	8(1.32)
Fy	1(0.77)	1(0.73)	1(0.58)	1(1.11)	0(0.00)	4(0.66)
D群
宋Ⅰ	3(2.31)	38(27.74)	24(13.87)	29(32.22)	13(17.11)	107(17.66)
宋Ⅱ	2(1.54)	8(5.84)	26(15.03)	13(14.44)	5(6.58)	54(8.91)

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表 3 幼儿分离株毒力基因分布模式[n(%)]

Table 3. Distribution patterns of virulence genes in infant isolates[n(%)]

组合模式	毒力基因类型				携带情况
组合模式	shET-1	shET-2	ipaH	ial	B群	D群
Ⅰ型	+	+	+	+	132(75.00)	6(3.41)
Ⅱ型	-	+	+	+	2(1.14)	22(12.50)
Ⅲ型	+	+	+	-	1(0.57)	0(0.00)
Ⅳ型	-	-	+	-	1(0.57)	4(2.27)
Ⅴ型	+	-	+	+	1(0.57)	1(0.57)
Ⅵ型	+	-	+	-	2(1.14)	4(2.27)

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表 4 幼儿分离株药物敏感性试验结果[n(%)]

Table 4. Drug susceptibility test results of infant isolates[n(%)]

药物名称	2013年(n=46)		2014年(n=37)		2015年(n=38)		2016年(n=26)		2017年(n=29)		χ_趋势²值	P值
药物名称	耐药	敏感	耐药	敏感	耐药	敏感	耐药	敏感	耐药	敏感	χ_趋势²值	P值
氨苄西林	45(97.83)	1(2.17)	36(97.30)	1(2.70)	37(97.37)	0(0.00)	23(88.46)	3(11.54)	28(96.55)	1(3.45)		0.165^a
头孢噻肟	23(50.00)	22(47.83)	18(48.65)	19(51.35)	22(59.46)	15(39.47)	12(46.15)	14(53.85)	14(48.28)	13(44.83)	1.357	0.852
头孢吡肟	1(2.14)	38(82.61)	7(19.44)	28(75.68)	2(5.26)	23(60.53)	1(3.85)	17(65.38)	1(3.45)	17(58.62)		0.130^a
头孢他啶	3(6.52)	41(89.93)	6(16.67)	30(81.08)	0(0.00)	37(97.37)	1(3.85)	24(92.31)	0(0.00)	27(93.1)		0.018^a
亚胺培南	0(0.00)	46(100.00)	0(0.00)	37(100.00)	0(0.00)	37(97.37)	0(0.00)	26(100.00)	1(3.45)	28(96.55)		0.520^a
庆大霉素	13(28.26)	33(71.74)	12(33.33)	25(67.57)	16(42.11)	22(57.89)	7(26.92)	19(73.08)	17(58.62)	12(41.38)	9.218	0.056
氯霉素	41(89.13)	4(8.70)	26(70.27)	11(29.73)	26(68.42)	11(28.95)	17(65.38)	9(34.62)	19(65.52)	10(34.48)	9.502	0.050
四环素	45(97.83)	1(2.17)	37(100.00)	0(0.00)	35(92.11)	1(2.63)	24(92.31)	2(7.69)	23(79.31)	6(20.69)		0.004^a
诺氟沙星	32(69.57)	12(26.09)	23(62.16)	12(32.43)	23(60.53)	13(34.21)	16(61.54)	10(38.46)	18(62.07)	10(34.48)	1.227	0.874
环丙沙星	33(71.74)	13(28.26)	22(61.11)	12(32.43)	24(63.16)	1(2.63)	15(57.69)	11(42.31)	18(62.07)	11(37.93)	11.312	0.023
复方新诺明	30(65.22)	15(32.61)	27(72.97)	10(27.03)	28(73.68)	10(26.32)	26(100.00)	0(0.00)	28(96.55)	1(3.45)	18.134	0.001
注：^a采用fisher精确概率法。

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表 5 福氏志贺菌和宋内志贺菌的药物敏感性结果比较[n(%)]

Table 5. Comparison of drug susceptibility between Shigella flexneri and Shigella sonnei [n(%)]

药物名称	福氏志贺菌(n=138)		宋内志贺菌(n=38)		χ²值	P值
药物名称	耐药	敏感	耐药	敏感	χ²值	P值
氨苄西林	134(97.10)	3(2.17)	34(89.47)	4(10.53)	3.432	0.064
头孢噻肟	66(47.83)	66(47.83)	19(50.00)	17(44.74)	0.087	0.768
头孢吡肟	8(5.80)	100(72.46)	4(10.53)	22(57.89)	0.803	0.370
头孢他啶	8(5.80)	126(91.30)	2(5.26)	32(84.21)	0.000	1.000
亚胺培南	2(1.45)	135(97.83)	0(0.00)	38(100.00)		1.000^a
庆大霉素	43(31.16)	94(68.12)	21(55.26)	17(44.74)	7.311	0.007
氯霉素	115(83.33)	22(15.94)	14(36.84)	22(57.89)	30.512	0.000
四环素	128(92.75)	8(5.80)	34(89.47)	2(5.26)	0.000	1.000
诺氟沙星	94(68.12)	37(26.81)	17(44.74)	21(55.26)	9.539	0.002
环丙沙星	97(70.29)	31(22.46)	14(36.84)	15(39.47)	8.635	0.003
复方新诺明	102(73.91)	36(26.09)	37(97.37)	1(2.63)	9.873	0.002
注：^a采用fisher精确概率法。

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