3年175例儿童细菌性痢疾的流行病学及临床分析

Epidemiological and clinical analysis on bacillary dysentery in 175 children in three years

摘要:

目的了解近3年儿童细菌性痢疾的流行病学与临床特点、菌群及耐药性变化。方法对某院2010—2012年儿科肠道门诊收治的经粪便培养确诊的175例细菌性痢疾患儿病历资料进行回顾性分析。结果儿童细菌性痢疾的发病高峰在7～9月份（占74.86%）；主要集中在1~3岁（不含1岁含3岁）、3~5岁（不含3岁含5岁）两个年龄段（分别占23.43%、25.14%）；临床表现主要为腹泻（100%）、阵发性腹痛 (94.29%)、发热 (77.14%)，脓血便、里急后重的典型症状较以往减少。分离福氏志贺菌113株(64.57%)，宋内志贺菌62株(35.43%)。药敏结果显示，175株志贺菌对氨苄西林、氨苄西林/舒巴坦、复方磺胺甲口恶唑有很高的耐药率，分别达到97.14%、72.57%、78.29%；对庆大霉素、环丙沙星、诺氟沙星、左氧氟沙星的敏感率仍较高（耐药率为4.57%～16.57%）；对头孢噻肟、头孢他啶的敏感率均在95%以上。结论儿童细菌性痢疾不典型病例在逐渐增多；本地志贺菌菌型以福氏志贺菌为主；志贺菌对一些抗菌药物的敏感性发生了较大变化，医生在使用抗菌药物时应引起重视。

Abstract:

ObjectiveTo investigate the epidemiological and clinical characteristics, pathogen species, and antimicrobial resistance of bacillary dysentery in children in recent three years.MethodsClinical data of 175 children with bacillary dysentery in a hospital in 20102012 were analyzed retrospectively. ResultsPeaks month of occurrence of bacterial dysentery in children was in JulySeptember (74.86%), incidence in children in 1-3 years old group (1 year old was excluded, 3 years old was included) was 23.43%, and  in  3-5 years old group (3 years old was excluded, 5 years old was included) was 25.14%. The main clinical manifestations were diarrhea （100%）, paroxysmal abdominal pain(94.29%),and fever (77.14%), but the typical symptoms of bloody purulent stool and tenesmus were less than the previous. The isolation rate of Shigella flexneri and Shigella sonnei was 64.57% (n=113) and 35.43% (n=62) respectively. Antimicrobial susceptibility test result revealed that the resistance rate of 175 Shigella isolates  to ampicillin, ampicillin/sulbactam, and compound sulfamethoxazole  was 97.14%, 72.57%, and 78.29% respectively; sensitivity rate to gentamicin, ciprofloxacin, norfloxacin,  and  levofloxacin  were  still  high ,  resistance rates were 4.57%-16.57%,  sensitivity rate to cefotaxime and ceftazidime were up to more than 95%. ConclusionAtyptical bacillary dysentery in children increases gradually; the major Shigella in local area is Shigella flexneri; Susceptibility of Shigella to some antimicrobial agents changed obviously, antimicrobial use should be paid attention.