食源性相关腹泻肠炎沙门菌感染抗菌药物敏感性

目的了解食源性相关腹泻非伤寒沙门菌感染的菌种分布及其对抗菌药物敏感性,为控制该类细菌的感染及传播提供技术支持。方法对2015-2017年本系统2家社区卫生服务中心就诊的食源性相关腹泻患者粪便(或肛拭子)标本采用直接分离与增菌分离相结合的方法常规培养分离获得42株沙门菌;采用血清凝集法进行快速血清分型,并进行自动化生化鉴定及抗菌药物敏感性试验;通过现况调查进行流行病学危险因素分析。结果自动化生化鉴定结果能够覆盖常规血清学快速鉴定结果,同属沙门菌群;42株沙门菌以肠炎沙门菌、鼠伤寒沙门菌和斯坦利沙门菌为主,其中肠炎沙门菌占全部菌株的23.81%,鼠伤寒沙门菌占19.06%,斯坦利沙门菌占14.29%;其中肠炎沙门菌可对氟喹诺酮类、三四代头孢菌素类与碳青霉烯类等敏感(敏感率可达97.00%以上),而对氨基糖苷类可产生双向耐药。通过现况调查,发现患者有腹痛、腹泻等胃肠道症状,可伴有发热,所有患者48h内有可疑食物暴露史,无水源性案例,均为散发。结论菌种鉴定应以常规快速血清学凝集结果为准,自动化生化鉴定仅供参考,并将鉴定菌种与药敏报告相关联,可根据药敏结果合理选用敏感抗菌药物;应对社区居民开展针对性的健康宣教。

The antimicrobial susceptibility of Salmonella enteritis in foodborne diarrhea

Abstract: Objective To explore the distribution and antimicrobial susceptibility of the pathogens in non-typhoidal Salmonella infections related to foodborne diarrhea, and provide technical support for control of the infection and transmission of the disease during Salmonella outbreaks. Methods The stool specimens (or anal swabs) of foodborne diarrhea patients in 2 community health service centers in Xihu district during 2015 and 2017 were cultured, from which 42 strains of Salmonella were isolated using direct separation combined with enrichment culture and isolation. Rapid serotyping was conducted by using serum agglutination test; automated biochemical identification and antimicrobial susceptibility test were done. The risk factors were analyzed through epidemiological investigation. Results Both the results of automatic biochemical identification and rapid serological identification showed that the 42 strains belong to Salmonella group, mainly including Salmonella enteritidis (23.81%), Salmonella typhimurium (19.06%) and Salmonella stanley (14.29%). The Salmonella enteritis was sensitive to fluoroquinolones, third/fourth-generation cephalosporins and carbapenems with a sensitivity rate of 97.00%, while resistant to all of aminoglycosides. Epidemiological investigation found that the patients had abdominal pain, diarrhea and other gastrointestinal tract symptoms, sometimes associated with fever. All the patients had history of exposure to suspected food within 48 hours. There was no waterborne case, and these cases were sporadic. Conclusion The identification of strains should be based on the results of routine rapid serological agglutination test, with automatic biochemical identification as a reference. The result of identification of bacteria should be combined with drug sensitivity report. Rational use of sensitive antibiotics based on the results of drug sensitivity test is recommended. Targeted health education should be provided for community residents.