| 贾蕾,吕冰,田祎,张新,刘重程,彭华,李洪军,甄博珺,王小莉,黄瑛,曲梅,王全意.北京市2008-2017年细菌性痢疾病原学监测分析[J].中华流行病学杂志,2019,40(2):165-169 |
| 北京市2008-2017年细菌性痢疾病原学监测分析 |
| Pathogenic surveillance and related factors on bacillary dysentery in Beijing, 2008-2017 |
| 收稿日期:2018-09-10 出版日期:2019-01-31 |
| DOI：10.3760/cma.j.issn.0254-6450.2019.02.008 |
| 中文关键词: 细菌性痢疾 诊断符合率 多因素分析 耐药 |
| 英文关键词: Bacillary dysentery Diagnostic accordance rate Multivariate analysis Resistance |
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| 中文摘要: |
| 目的 分析2008-2017年北京市细菌性痢疾（菌痢）病原学监测资料，为菌痢防治提供参考。方法 分析2008-2017年北京市两个菌痢国家级监测点数据，以标本检出志贺菌为菌痢诊断的金标准，描述志贺菌的阳性率、菌痢的诊断符合率及耐药情况，率的比较采用χ2检验，应用非条件logistic回归分析志贺菌阳性的相关因素。结果 2008-2017年，北京市菌痢报告发病率和腹泻患者的志贺菌阳性率均明显下降，菌痢的临床诊断符合率为7.80%（111/1 423）。北京市菌痢的病原以宋内志贺菌为主，占73.95%（159/215），其他均为福氏志贺菌。采用非条件logistic回归分析志贺菌阳性的相关因素，便常规阳性（与阴性相比，OR=1.863，95% CI：1.402~2.475）、7-10月发病（与其他月份比较，OR=7.271，95% CI：4.514~11.709）、体温≥ 38℃（与体温<38℃比较，OR=4.516，95% CI：3.369~6.053）和6~59岁（与其他年龄比较，OR=1.617，95% CI：1.085~2.410）的志贺菌阳性率更高。氨苄西林（97.57%，201/206）和萘啶酸（94.90%，186/196）的耐药率最高，环丙沙星（16.33%，32/196）、氧氟沙星（9.57%，11/115）及阿莫西林（15.05%，31/206）耐药率较低；福氏志贺菌的耐药情况较宋内志贺菌更为严重；耐药≥ 3种抗菌素的比例为30.00%（21/70）。结论 北京市菌痢临床诊断符合率低，耐药情况较严重，临床医生做出诊断时应综合考虑腹泻患者的流行病学史、临床表现以及实验室检测结果。 |
| 英文摘要: |
| Objective To analyze the pathogenic surveillance programs and related factors on bacillary dysentery in Beijing, 2008-2017, to provide evidence for the practices of diagnosis, treatment and prevention of the disease. Methods Analysis was conducted on surveillance data of bacillary dysentery, collected from the surveillance areas of national bacillary dysentery in Beijing. Shigella positive rate of stool samples were used as the gold standard while detection rate of Shigella, diagnostic accordance rate and resistance were computed on data from the surveillance programs. Chi-square test was used to compare the rates and unconditional logistic regression was used to analyze the related factors of Shigella infection. Results Both the reported incidence rate on bacillary dysentery and detection rate of Shigella in diarrhea patients showed significantly decreasing trend, from 2008 to 2017. The accordance rate of bacillary dysentery was only 7.80% (111/1 423). Shigella sonnei was the most frequently isolated strain (73.95%, 159/215) followed by Shigella flexnery. Results from the multivariate logistic regression of Shigella positive rate revealed that among those patients who were routine test of stool positive vs. routine test of stool positive (OR=1.863, 95% CI:1.402-2.475), onset from July to October vs. other months' time (OR=7.271, 95% CI:4.514-11.709) temperature ≥ 38℃ vs. temperature <38℃(OR=4.516, 95% CI:3.369-6.053) and age from 6 to 59 years old vs. other ages (OR=1.617, 95% CI:1.085-2.410), presenting higher positive detection rates of Shigella from the stool tests. The resistant rates on ampicillin and nalidixic acid were 97.57% (201/206) and 94.90% (186/196), both higher than on other antibiotics. The resistant rates on ciprofloxacin (16.33%, 32/196), ofloxacin (9.57%, 11/115) and on amoxilin (15.05%, 31/206) were relatively low. The resistant rate appeared higher on Shigella flexnery than on Shigella sonnei. The proportion of strains with resistance on 3 more drugs, was 30.00%(21/70). Conclusions The diagnostic accordance rate of bacillary dysentery in Beijing was low, with severe resistance of Shigella. Our findings suggested that clinicians should take multiple factors into account in their practices about epidemiological history, clinical symptom and testing results for diarrhea patients. |
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