1991至2017年某儿童专科医院儿童细菌性腹泻病原菌分布变迁

doi:10.3969/j.issn.1673-5501.2019.03.003

摘要/Abstract

摘要： 目的了解重庆医科大学附属儿童医院(我院)27年儿童细菌性腹泻中肠道病原菌的分布情况。方法回顾性分析我院1991年1月1日至2017年12月31日以腹泻起病的住院患儿,送检粪便标本的细菌培养阳性的菌株情况。同一患儿同一次住院期间,如多次送检粪便标本且分离出相同的菌株,仅纳入第1次的记录进行分析。截取患儿性别、年龄、居住环境,粪便标本中阳性病原菌的类别和检出时间等。结果 33 957份粪便标本中共分离到肠道病原菌2 409株(7.09%),志贺菌属占78.83%(1 899株),其中以福氏志贺菌为主(87.36%,1 659/1 899株),又以福氏Ⅱ型志贺菌多见(97.17%,1 612/1 659株);沙门菌属占13.24%(319株),其中以鼠伤寒沙门菌为主(69.28%,221/319株);致泻性大肠埃希菌占5.06%(122株),其中以致病性大肠埃希菌为主(77.05%,94/122株)。1995年检出率27.67%(249/900株),2000年前(除1992年)检出率均＞10%,2000年后检出率＜5%;8~10月份病原菌株数和检出率最高。1991至1999年(n=1 860株)、~2008年(n=348株)、~2017年(n=201株)比较,福氏Ⅱ型志贺菌在所有肠道病原菌中的占比由80.48%降至0,鼠伤寒沙门菌占比由4.35%上升至58.71%。婴儿中鼠伤寒沙门菌的占比最高(29.58%),其他年龄段均以福氏Ⅱ型志贺菌占比最高。结论我院儿童细菌性腹泻的主要病原菌1991至1999年以福氏Ⅱ型志贺菌居多;～2017年以鼠伤寒沙门菌多见。

关键词: 病原性细菌, 儿童, 细菌性腹泻

Abstract: Objective To study the species distribution of pathogenic bacteria in children with bacterial diarrhea in Chongqing in the past 27 years, and to provide scientific basis in prevention and treatment of children's bacterial diarrhea in Chongqing.Methods A retrospective study was conducted on the bacterial culture-positive strains of fecal specimens from hospitalized children with diarrhea from January 1, 1991 to December 31, 2017.During the same hospitalization period of the same child, if fecal specimens were sent for multiple times and the same strain was isolated, only the first record was included for analysis.The gender, age, living environment of the children, and the type and time of detection of positive pathogenic bacteria in fecal specimens were selected.Results 2,409 strains of pathogenic bacteria were isolated from 33,957 fecal specimens of children with diarrhea during the past 27 years, with the total detection rate being 7.09%, including Shigella spp.(78.83%, 1,899/2,409),mainly Shigella flexneri (87.36%,1,659/1,899), of which S.flexneri Type Two was more common (97.17%,1,612/1,659);Salmonella spp.(13.24%,319/2,409), mainly Salmonella typhimurium(69.28%,221/319); Diarrheal escherichia coli(5.06%,122/2,409),mainly pathogenic E.coli(77.05%,94/122).In terms of the detection period, the detection rate was the highest in 1995, which was 27.67%(249/900). Before 2000 (except 1992), the detection rate was >10%, and after 2000, it fell to below 5%;The number and detection rate of pathogenic bacteria were the highest in August, September and October. From the year 1991 to 1999 (n=1,860), the year 2000 to 2008 (n=348), and the year 2009 to 2017 (n=201), the proportion of S.flexneri Type Two was decreased from 80.48% to 0,and the proportion of Salmonella typhimurium increased from 4.35% to 58.71%. The proportion of Salmonella typhimurium in infants was the highest (29.58%), and the proportion of S.flexneri Type Two was the highest in other age groups.Conclusion The dominant pathogenic bacteria species causing bacterial diarrhea in children was S.flexneri Type Two in the early time period (from the year 1991 to 1999), while Salmonella typhimurium was more predominant in late time period (from the year 2009 to 2017).

Key words: Bacterial diarrhea, Chlidren, Pathogenic bacteria

朱静, 许红梅, 张明强, 熊菀, 赵瑞秋. 1991至2017年某儿童专科医院儿童细菌性腹泻病原菌分布变迁[J]. 中国循证儿科杂志, 2019, 14(3): 176-180.

ZHU Jing, XU Hong-mei, ZHANG Ming-qiang, XIONG Wan, ZHAO Rui-qiu. Distribution of pathogenic bacteria in children with bacterial diarrhea in a children's hospital from 1991 to 2017[J]. Chinese Journal of Evidence -Based Pediatric, 2019, 14(3): 176-180.

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