| 丰俊,夏佳慧,庄源,徐桢,罗嘉远,陈涌,费加艺,吴艺童,吴寰宇,陈昕,张静,陈敏.上海市2016-2022年腹泻病例致泻性大肠埃希菌感染的流行特征与耐药分析[J].中华流行病学杂志,2024,45(7):969-976 |
| 上海市2016-2022年腹泻病例致泻性大肠埃希菌感染的流行特征与耐药分析 |
| Epidemiological characteristics and drug resistance of diarrheagenic Escherichia coli infection in diarrhea patients in Shanghai, 2016-2022 |
| 收稿日期:2024-01-24 出版日期:2024-07-13 |
| DOI：10.3760/cma.j.cn112338-20240124-00040 |
| 中文关键词: 腹泻 致泻性大肠埃希菌 肠产毒性大肠埃希菌 流行特征 耐药性 |
| 英文关键词: Diarrhea Diarrheagenic Escherichia coli Enterotoxigenic Escherichia coli Epidemiological characteristics Drug resistance |
| 基金项目:上海市加强公共卫生体系建设三年行动计划（2023-2025）学科带头人项目（GWVI-11.2-XD28）;上海市加强公共卫生体系建设三年行动计划（2023-2025）重点学科项目（GWVI-11.1-09）;上海市虹口区卫生健康委员会医学科研课题计划（虹卫2303-17） |
| 作者 | 单位 | E-mail | | 丰俊 | 上海市疾病预防控制中心, 上海 200336 | | | 夏佳慧 | 上海市虹口区疾病预防控制中心, 上海 200082 | | | 庄源 | 上海市疾病预防控制中心, 上海 200336 | | | 徐桢 | 上海市疾病预防控制中心, 上海 200336 | | | 罗嘉远 | 上海市疾病预防控制中心, 上海 200336 | | | 陈涌 | 上海市疾病预防控制中心, 上海 200336 | | | 费加艺 | 上海市疾病预防控制中心, 上海 200336 | | | 吴艺童 | 上海市疾病预防控制中心, 上海 200336 | | | 吴寰宇 | 上海市疾病预防控制中心, 上海 200336 | | | 陈昕 | 上海市疾病预防控制中心, 上海 200336 | | | 张静 | 上海市虹口区疾病预防控制中心, 上海 200082 | | | 陈敏 | 上海市疾病预防控制中心, 上海 200336 | chenmin@scdc.sh.cn |
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| 中文摘要: |
| 目的 掌握上海市腹泻病例致泻性大肠埃希菌（DEC）的感染情况、流行病学特征及耐药情况，为后续监测和防控提供数据支撑。方法 基于上海市腹泻病综合监测系统收集2016-2022年肠道腹泻门诊病例的流行病学资料，采集粪便标本，开展DEC检测。基于国家致病菌识别网系统收集2016-2022年药敏监测数据。统计学分析采用χ2检验或Fisher确切概率法。结果 在24 883例感染性腹泻患者中，DEC阳性率为9.13%（2 271/24 883），其中单一致病型DEC阳性率为8.83%（2 197/24 883），混合致病型DEC阳性率为0.30%（74/24 883）。DEC阳性主要型别为肠产毒性大肠埃希菌［4.33%（1 077/24 883）］，以≤5岁组人群的DEC阳性率最高［18.48%（22/119）］。2016-2022年DEC阳性率最高月份为7-9月［5.91%（1 470/24 883）］。2016-2022年市区和郊区的DEC阳性率分别为9.47%（554/5 847）和9.02%（1 717/19 036），市区和郊区的DEC主要型别分别为肠黏附性大肠埃希菌［3.98%（233/5 847）］和肠产毒性大肠埃希菌［4.56%（868/19 036）］。2016-2019和2020-2022年DEC阳性率分别为9.42%（1 821/19 330）和8.10%（450/5 553），主要型别分别为肠产毒性大肠埃希菌（4.87%，941/19 330）和肠黏附性大肠埃希菌（4.70%，261/5 553）。耐药菌株的多重耐药率为40.21%（618/1 537）。耐药率较高的前三位药物依次为氨苄西林［64.74%（995/1 537）］、萘啶酸［58.49%（899/1 537）］和四环素［45.09%（693/1 537）］。结论 相比于2016-2019年，2020-2022年DEC阳性率下降，主要型别由肠产毒性大肠埃希菌转变为肠黏附性大肠埃希菌。多重耐药现象较严重，建议应加强DEC的耐药性持续监测，同时规范临床抗生素的使用。 |
| 英文摘要: |
| Objective To understand the infection status, epidemiological characteristics and drug resistance of Diarrheagenic Escherichia coli (DEC) in Shanghai and provide evidence for the disease surveillance. Methods The epidemiological data of diarrhea cases in Shanghai from 2016 to 2022 were collected from Shanghai Diarrhea Comprehensive Surveillance System, and stool samples were collected from the cases for DEC detection. The drug resistance data was obtained from Chinese Pathogen Identification Network. Statistical analysis was conducted by using χ2and fisher test. Results In 24 883 diarrhea cases detected during 2016-2022, the DEC positive rate was 9.13% (2 271/24 883), the single DEC positive rate was 8.83% (2 197/24 883) and the mixed DEC positive rate was 0.30% (74/24 883). The main type of DEC was Enterotoxigenic Escherichia coli (ETEC) [4.33% (1 077/24 883)]. The DEC positive rate was highest in people aged ≤5 years 18.48% (22/119). The annual peak of DEC positive rate was observed during July - September [5.91% (1 470/24 883)]. The DEC positive rate were 9.47% (554/5 847) and 9.02% (1 717/19 036) in urban area and in suburbs, respectively, Enteroaggregative Escherichia coli (EAEC) [3.98% (233/5 847)] and ETEC [4.56% (868/19 036)] were mainly detected. From 2016 to 2019, the DEC positive rate was 9.42% (1 821/19 330), while it was 8.10% (450/5 553) from 2020 to 2022, the main DEC types were ETEC (4.87%, 941/19 330) and EAEC (4.70%, 261/5 553). The multi-drug resistance rate was 40.21% (618/1 537). The top three antibiotics with high drug resistance rates were ampicillin [64.74% (995/1 537)], nalidixic acid [58.49% (899/1 537)] and tetracycline [45.09% (693/1 537)]. Conclusions Compared with 2016- 2019, a decrease in DEC detection rate was observed during 2020-2022, and the main type of DEC detected shifted from ETEC to EAEC. The prevalence of multi-drug resistance was severe. Therefore, it is necessary to further strengthen the surveillance for DEC drug resistance and standardize the use of clinical antibiotics. |
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