攀枝花市沙门菌临床分离株血清型和分子分型特征分析

doi:10.3969/j.issn.1673-8640.2021.11.007

摘要/Abstract

摘要：

目的分析攀枝花市沙门菌感染病例的临床特征及沙门菌临床分离株的血清型、抗菌药物耐药性和分子分型特征。方法收集2018—2019年攀枝花市4家哨点医院沙门菌临床分离株90株,进行血清型、耐药性和脉冲场凝胶电泳（PFGE）检测。参考国家致病菌识别网方案进行多维表型特征分析。结果 90例沙门菌感染病例中,肠内腹泻79例、肠外侵袭感染11例;15个血清型中,腹泻优势型为鼠伤寒沙门菌（45株）、肠炎沙门菌（18株）、伦敦沙门菌（3株）、斯坦利沙门菌（3株）和韦太夫雷登沙门菌（3株）;侵袭型为肠炎沙门菌（6株）、甲型副伤寒沙门菌（2株）、鼠伤寒沙门菌、德比沙门菌和乌撒拉茂沙门菌（各1株）;优势年龄组为<5岁幼儿和20~59岁成年人,男性多于女性;腹泻春、夏季高发。鼠伤寒沙门菌和肠炎沙门菌耐药性差异有统计学意义（P<0.05）,鼠伤寒沙门菌对氟喹诺酮和三代头孢类抗菌药物较敏感,肠炎沙门菌对氟喹诺酮类（萘啶酸和环丙沙星）高度耐药,对头孢噻肟的耐药率>20%。 PFGE证实腹泻优势型的鼠伤寒沙门菌有3个流行克隆,其中2个为多重耐药（MDR）;肠炎沙门菌、伦敦沙门菌、斯坦利沙门菌和韦太夫雷登沙门菌均表现为耐药或敏感的单一克隆。结论攀枝花市沙门菌临床分离株血清型具有多样性,分子克隆特征为多耐药。鼠伤寒沙门菌和肠炎沙门菌、肠炎沙门菌和甲型副伤寒沙门菌分别是肠内和肠外感染的优势菌型。加强医防结合的公共卫生监测,提高区域监测共享国家致病菌识别网的大数据利用率,能精准应对和预警各类沙门菌感染疫情。

关键词: 沙门菌, 血清型, 分子克隆, 耐药性, 临床诊断, 多重耐药

Abstract:

Objective To study the clinical characteristics of Salmonella infection cases and the serotyping,molecular subtyping and drug resistance of Salmonella isolates in Panzhihua,Sichuan. Methods A total of 90 Salmonella isolates from 4 sentinel hospitals in Panzhihua were collected from 2018 to 2019. According to the National Pathogen Identification Network,serotyping determination,drug resistance determination and pulsed field gel electrophoresis（PFGE）were carried out. Results The 90 Salmonella isolates from clinical cases including 79 intestinal diarrhea cases and 11 extra-intestinal invasion cases were confirmed into 15 serotypes. The most common serotype from intestinal diarrhea cases was Salmonella typhimurium（45 isolates）,followed by Salmonella enteritidis（18 isolates）,Salmonella london（3 isolates）,Salmonella stanley（3 isolates） and Salmonella weltevreden（3 isolates）,while the most common serotype from extra-intestinal invasion cases was Salmonella enteritidis（6 isolates）,followed by Salmonella paratyphi A（2 isolates）,Salmonella typhimurium（1 case）,Salmonella derby（1 case）and Salmonella uzaramo（1 case）. Children under 5-year-old and 20-59-year-old adults were the high risk groups. There were more cases in males than in females,and spring and summer were the common seasons of high incidence of diarrhea. Drug resistance results of Salmonella typhimurium and Salmonella enteritidis had statistical significance（P<0.05）. Salmonella typhimurium isolates were still sensitive to fluoroquinolones and third-generation cephalosporins,while Salmonella enteritidis isolates were highly resistant to fluoroquinolones（nalidixic acid and ciprofloxacin）,and cefotaxime resistance rate was >20%. PFGE showed that Salmonella isolates from diarrhea cases had 3 dominant clusters,2 of which were multiple-drug resistant（MDR）. Salmonella enteritidis,Salmonella london,Salmonella stanley and Salmonella weltevreden isolates only had one drug resistant or sensitive cluster. Conclusions The Salmonella isolates in Panzhihua illustrate serotype diversity and MDR molecular clone. Salmonella typhimurium,Salmonella enteritidis and Salmonella enteritidis,Salmonella paratypli A are the most common serotypes from intestinal diarrhea and extra-intestinal invasion cases,respectively. Improving regional surveillance and sharing the big data of the National Pathogen Identification Network should be strengthened,so that we can have accurate response and early warning of various Salmonella outbreaks.

Key words: Salmonella, Serotype, Molecular clone, Drug resistence, Clinical diagnosis, Multiple-drug resistance

中图分类号:

R378.2

陈嫣, 崔琳, 黄伟峰, 封正娟, 刘玥, 许学斌. 攀枝花市沙门菌临床分离株血清型和分子分型特征分析[J]. 检验医学, 2021, 36(11): 1125-1130.

CHEN Yan, CUI Lin, HUANG Weifeng, FENG Zhengjuan, LIU Yue, XU Xuebin. Characteristics of Salmonella isolate serotyping and molecular subtyping in Panzhihua,Sichuan[J]. Laboratory Medicine, 2021, 36(11): 1125-1130.

图/表 3

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抗菌药物	沙门菌（90株）	鼠伤寒沙门菌（46株）	肠炎沙门菌（24株）	χ²值	P值
氨苄西林	47.78	36.96	79.17	11.25	<0.05
头孢他啶	7.78	6.52	4.17	0.00	>0.05
氨苄西林-舒巴坦	44.44	30.43	79.17	15.03	<0.05
亚胺培南	1.11	0.00	4.17	0.11	>0.05
四环素	43.33	58.70	12.50	13.74	<0.05
萘啶酸	60.00	54.35	95.83	12.60	<0.05
头孢西丁	4.44	2.17	0.00	0.00	>0.05
氯霉素	18.89	19.57	4.17	1.93	>0.05
头孢噻肟	13.33	8.70	20.83	1.13	>0.05
头孢唑啉	63.33	60.87	87.50	5.33	<0.05
庆大霉素	7.78	6.52	0.00	0.43	>0.05
氨曲南	5.56	2.17	0.00	0.00	>0.05
环丙沙星	64.44	54.35	95.83	12.60	<0.05
复方磺胺甲噁唑	17.78	21.74	0.00	4.44	<0.05
MDR	48.89	39.13	79.17	10.15	<0.05
ACT/S	12.22	10.87	0.00	1.41	>0.05
ACT/ST	12.22	10.87	0.00	1.41	>0.05

抗菌药物	沙门菌（90株）	鼠伤寒沙门菌（46株）	肠炎沙门菌（24株）	χ²值	P值
氨苄西林	47.78	36.96	79.17	11.25	<0.05
头孢他啶	7.78	6.52	4.17	0.00	>0.05
氨苄西林-舒巴坦	44.44	30.43	79.17	15.03	<0.05
亚胺培南	1.11	0.00	4.17	0.11	>0.05
四环素	43.33	58.70	12.50	13.74	<0.05
萘啶酸	60.00	54.35	95.83	12.60	<0.05
头孢西丁	4.44	2.17	0.00	0.00	>0.05
氯霉素	18.89	19.57	4.17	1.93	>0.05
头孢噻肟	13.33	8.70	20.83	1.13	>0.05
头孢唑啉	63.33	60.87	87.50	5.33	<0.05
庆大霉素	7.78	6.52	0.00	0.43	>0.05
氨曲南	5.56	2.17	0.00	0.00	>0.05
环丙沙星	64.44	54.35	95.83	12.60	<0.05
复方磺胺甲噁唑	17.78	21.74	0.00	4.44	<0.05
MDR	48.89	39.13	79.17	10.15	<0.05
ACT/S	12.22	10.87	0.00	1.41	>0.05
ACT/ST	12.22	10.87	0.00	1.41	>0.05