| 王鸣柳,阚飙,杨进,林玫,闫梅英,曾竣,权怡,廖和壮,周凌云,蒋震羚,黄德蕙.广西壮族自治区1994-2013年伤寒流行病学特征及菌株耐药分析[J].中华流行病学杂志,2014,35(8):930-934 |
| 广西壮族自治区1994-2013年伤寒流行病学特征及菌株耐药分析 |
| Epidemiological characteristics of typhoid fever and antibiotic susceptibility testing of Salmonella Typhi isolates in Guangxi,1994-2013 |
| 收稿日期:2014-01-23 出版日期:2014-08-30 |
| DOI：10.3760/cma.j.issn.0254-6450.2014.08.012 |
| 中文关键词: 伤寒沙门菌 流行病学 耐药谱 |
| 英文关键词: Salmonella Typhi Epidemiology Antibiotic resistant profile |
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| 中文摘要: |
| 目的 分析1994-2013年广西地区伤寒流行特征、菌株耐药特征及其变迁。方法 采用描述流行病学方法分析1994-2013年广西地区伤寒疫情报告资料，对分离自伤寒病例475株沙门菌，利用纸片扩散法及肉汤微量稀释法检测抗菌药物最小抑菌圈和抑菌浓度（MIC），依据CLSI 2012版敏感判定标准，判定菌株的耐药情况。结果 20年间广西地区共报告伤寒病例57 928例，年均发病率为6.29/10万，病死率为0.03%。<20岁人群发病较高，发病无性别差异，病例以农民和学生为主，主要分布在广西北部地区，全年均有发病，发病高峰在5-10月。2001-2013年发生13起大的暴发疫情，传播方式以水型为主。475株菌对第三代头孢类抗生素头孢噻肟和氟喹诺酮类诺氟沙星的敏感率为100%，对四环素、氯霉素、氨苄西林、庆大霉素的敏感率约为98%，对环丙沙星的敏感率为89.89%；对链霉素、复方新诺明的敏感性较低，为67.73%和65.89%。发现1株环丙沙星耐药、47株环丙沙星敏感性降低的菌株。暴发株与散发株耐药情况无差别。有28株菌耐≥3种抗生素，首次发现1株同时对氨苄西林、氯霉素、链霉素、复方新诺明、四环素、萘啶酸（ACSSxT-NAL）耐药的多重耐药菌株。多耐药株多见于伤寒小范围暴发疫情。结论 广西地区伤寒发病水平仍较高，且菌株出现对临床常用的氟喹诺酮类药物敏感性降低及多重耐药现象，应加强疫情及耐药监测。 |
| 英文摘要: |
| Objective Through analyzing the typhoid epidemics and to determine and monitor regional resistance characteristics of the shift of drug resistant profile on Salmonella(S.) Typhi,to understand the related epidemiological characteristics of typhoid fever and to provide evidence for the development of strategies,in Guangxi. Methods Data of typhoid fever from surveillance and reporting system between 1994 to 2013 was collected and statistically analyzed epidemiologically. The susceptibility of 475 S. Typhi isolates from patients on ten antibiotics was tested by broth micro-dilution method and minimum inhibition concentration was obtained and interpreted based on the CLSI standard. Results From 1994 to 2013,a total of 57 928 cases of typhoid fever were reported in Guangxi province with an annual incidence of 6.29/100 000 and mortality as 0.03%. The higher incidence was observed in the population under 20 years of age. There was no significant difference on incidence between male and female,but farmers and students were among the hardest hit groups. More cases were seen from the northern part of the province. Cases appeared all year round with the peak from May to October. A total of 13 major outbreaks during 2001 to 2013 were reported and the main transmission route was water-borne. All the strains were sensitive to third generation cephalosporins cefotaxime and fluoroquinolones norfloxacin. The susceptibility rates to tetracycline,chloramphenicol,ampicillin and gentamicin was around 98% but relative lower susceptible rate to ciprofloxacin was seen as 89.89%. The lowest susceptibility was found for streptomycin and sulfamethoxazole agents,with the rates as 67.73% and 65.89%,respectively. One strain was found to have been resistant to ciprofloxacin and another 47 isolates with reduced susceptibility to ciprofloxacin. Twenty eight isolates were found to be resistant to multiple antibiotics and one displayed ampicillin,chloramphenicol,streptomycin,sulfamethoxazole tetracycline and nalidixic acid (ACSSxT-NAL) resistance profile. This was the first report in China. Multi-drug resistant strains were frequently isolated from small scale outbreaks of typhoid fever. Conclusion The incidence of typhoid fever in Guangxi was still high and some strains showed multi-drug resistance and reduced susceptibility to ciprofloxacin,indicating that the surveillance and monitor programs on drug resistance of S. Typhi should be strengthened,to prevent large scale outbreaks of typhoid fever in this province. |
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