临床诊断成人细菌性痢疾414例的流行病学、临床及病原学特征

Epidemiological,clinical and pathogenic features of bacterial dysentery diagnosed clinically：Analysis of 414 patients

摘要:

目的了解某地区细菌性痢疾的临床及流行病学特点、致病菌群分布及耐药情况。方法以2010年7—9月就诊于某院肠道门诊的414例临床诊断细菌性痢疾患者为研究对象，对患者一般资料、症状体征、病原检测等结果进行统计分析。结果临床诊断细菌性痢疾患者以青壮年居多(50岁以下者322例,占77.78%)；左下腹压痛、脓血便、里急后重等典型临床表现较少见；志贺菌培养阳性率为16.43%（68/414），其中宋内志贺菌65株(95.59%)，福氏志贺菌3株(4.41%)。志贺菌株对氨苄西林、复方磺胺甲口恶唑、庆大霉素等耐药率均＞95%，甚至高达100.00%；对头孢菌素及部分喹诺酮类抗菌药物敏感，但对环丙沙星、洛美沙星敏感性较以往下降。结论该地区临床诊断细菌性痢疾患者的临床和流行病学特点较以往有所不同，志贺菌流行菌型变迁、耐药菌株增加，应引起医务工作者注意。

Abstract:

ObjectiveTo investigate the clinical and epidemiological features of acute bacterial dysentery and its pathogen distribution and drug resistance.MethodsThe data of age，occupation，symptoms，signs，and patterns of pathogen from 414 patients with bacillary dysentery between July 2010 and September 2010 were analyzed retrospectively.ResultsMost patients with bacillary dysentery were young adult(322 patients ［77.78%］ were under 50 years old) ; The typical clinical manifestations,such as left lower quadrant tenderness, pus and blood stool， and tenesmus were less common; The positive rate of fecal Shigella culture was 16.43%(68/414),65 (95.59%) of which were Shigella sonnei, 3 (4.41%)were Shigella flexneri. Drugresistant rates of Shigella to ampicillin,trimethoprimsulfamethoxazole,and gentamicin were over 95%,even up to 100.00%; The strains were sensitive to cephalosporins and some quinolones, but had a decreased sensitivity to ciprofloxacin and lomefloxacin.ConclusionCompared with the previous, the clinical and epidemiological features of bacterial dysentery and epidemic patterns of Shigella have changed, drugresistant strains increased.