分离自腹泻成人志贺菌的血清分群及耐药性分析

目的 调查志贺菌在成人腹泻患者中的主要血清群和耐药性,为临床治疗和预防提供依据.方法 对2008年1月至2012年10月浙江萧山医院临床分离自腹泻成人志贺菌菌株,进行生化鉴定、血清学分群和抗生素敏感性试验,所有数据用WHONET 5.6软件进行回顾性分析.结果 共检出125株志贺菌,其中66(52.8％)株为宋内志贺菌,58(46.4％)株为福氏志贺菌;氨苄西林耐药率最高达95.9％,复方新诺明耐药率达79.8％,头孢噻肟为48.6％,未检出头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、亚胺培南和美罗培南耐药株,福氏志贺菌对环丙沙星和左旋氧氟沙星耐药率为87.0％和57.1％,而宋内志贺菌未检出氟喹诺酮类耐药株;福氏志贺菌和宋内志贺菌耐药率在哌拉西林、头孢他啶、头孢噻肟、头孢吡肟、复方新诺明和氟喹诺酮间差异有统计学意义(P＜0.01).结论 萧山地区成人志贺菌感染以宋内和福氏两种血清群为主,青霉素类和复方新诺明耐药率太高已不适合临床使用,含酶抑制剂抗生素是治疗志贺菌感染的首选药物.     

苏浙闽地区婴幼儿急性腹泻患者病毒检测及 临床特征分析

目的分析苏浙闽地区婴幼儿急性腹泻患者常见病毒及患儿临床特征,为婴幼儿急性腹泻的流行病学研究和临床治疗提供参考。方法选取2010至2014年苏浙闽地区多家医院门诊就诊的急性腹泻患儿1 452例,采用ELISA法检测A组轮状病毒(HRV),多重PCR法检测诺如病毒(NoV)、肠道腺病毒(EAdV)和星状病毒(HAstV),并用RT-PCR法对A组轮状病毒阳性的样本进行G和P分型。结果 1 452例患儿中由常见病毒引起的急性腹泻患儿有707例,占总调查患者的48.69%。急性腹泻患儿常见病毒感染中单一病毒感染占90.10%(637/707),其感染病毒的构成以轮状病毒最多(47.52%,336/707),其次为诺如病毒(36.07%,255/707)以及星状病毒(2.40%,17/707)和肠道腺病毒(4.10%,29/707)。病毒感染腹泻患儿中多重感染者共70例,占9.90%(70/707),以A组轮状病毒合并诺如病毒感染最为常见,占多重感染者的68.57%(48/70)。226份A组轮状病毒阳性标本中,G分型以G1为优势分型,占33.19%;P分型中则以P [11]比例最高,占38.50%;G、P型组合以P [11]G11为主(38.50%)。结论 A组轮状病毒是引发婴幼儿急性腹泻的主要病毒,诺如病毒次之,且婴幼儿病毒性腹泻患者可合并多种病毒感染。不同地区腹泻患儿病毒感染阳性率有差异,轮状病毒基因型表现则具有多样性。     

腹泻便病原菌检验结果160例临床研究

目的:探讨腹泻病原菌的检验结果,以及产生的临床效果。方法:选取2014年5月到2015年6月在我院治疗的160例腹泻患者的粪便作为样本,观察不同菌属的检测率。结果:160例标本中,志贺菌属患者占45%,沙门菌属患者占15.6%。志贺菌属检出率最高,沙门菌数位居第二,明显高于其他菌属检测率,差异明显,p0.05,具有统计学意义。结论:产生腹泻的原因有很多种,有效的检测病原菌的致病菌,以及条件致病菌都是非常必要的。这样,才能在防治腹泻病的过程中,起到良好的临床效果。     

在我国患急性腹泻成人中发现一种新轮状病毒

从3例急性成人腹泻患者粪便中,经电镜观察,成人腹泻轮状病毒—酶联免疫吸附试验(ADRV-ELISA)、普通轮状病毒—酶联免疫吸附试验(Rota-ELISA),猪抗C型(组)轮状病毒和鸡抗D型(组)轮状病毒血清分别与本病毒的免疫电镜试验以及RNA电泳等实验结果,发现了一种新轮状病毒,该病毒的形态结构与普通轮状病毒(Rotavirus)、成人腹泻论状病毒(Adult Diarrhoea Rotavirus,简称ADRV)极为相似,但抗原性与普通轮状病毒(A组),成人腹泻轮状病毒(B组),C型轮状病毒(C组),D型轮状病毒(D组)显然无关。基因分析表明,该病毒基因组由11个双链RNA片段组成,但其RNA电泳图型具有独自的特点,与目前公认的A组、B组、C组、D组论状病毒韵RNA电泳图型均不同,免疫电镜证实,该病毒能被人恢复期血清所凝集,表明该病毒可能是腹泻病人的病因。     

2007年上海市儿童社区获得性腹泻致病菌谱分析

为了解上海地区社区获得性腹泻儿童致病菌流行病学情况,对2007年度就诊于我院的2871例社区获得性腹泻患儿进行粪便弯曲菌、志贺菌、沙门菌,霍乱弧菌、副溶血性弧菌、致腹泻大肠埃希菌、气单胞菌、耶尔森菌进行培养分离、鉴定及部分菌株的血清分型。结果发现,弯曲菌在腹泻患儿粪便中的分离率为11.1%(172/1556),4月份感染率最高(P<0.001),多见于1～4岁儿童(P<0.05);其次是志贺菌,分离率为3.2%(91/2871),其中福氏志贺菌占63.7%;第3位是致腹泻大肠埃希菌,分离率为1.0%(30/2871),其中肠致病性大肠埃希菌占70.0%,以O55/K59血清型为主。沙门菌、气单胞菌分离率不超过0.5%,未检测到霍乱弧菌、副溶血性弧菌和耶尔森菌。本次调查显示,弯曲菌、志贺菌、致腹泻大肠埃希菌是目前上海地区儿童社区获得性腹泻的3种主要致病菌。弯曲菌感染率明显高于志贺菌及致腹泻大肠埃希菌,提示临床微生物室应将弯曲菌、致腹泻大肠埃希菌作为儿童社区获得性腹泻常规监测的病原微生物。     

婴幼儿腹泻病原学及其快速诊断

目的探讨小儿腹泻标本病原学特点及流行病学特征,寻求小儿感染性腹泻的快速诊断方法。方法对我院2003年10月至2005年9月门诊及住院的1160例2个月-5岁腹泻患儿的腹泻标本进行细菌学检查及pH检测。结果(1)1160例患儿腹泻标本病原学阳性605例(52.16%),检出病原20种621株,外源性肠道病原菌、内源性肠道条件致病菌以及轮状病毒3种病原构成比依次为35.75%、32.69%、31.56%。主要病原:(1)轮状病毒196株(31.56%),志贺菌118株(19.00%),克雷伯菌86株(13.8%),枸橼酸杆菌67株(10.79%),致泻性大肠埃希菌60株(9.66%)。(2)1160例患儿腹泻标本6个月-2岁患儿占881例(69.91%)。轮状病毒腹泻多发于秋冬季、大便为水样、多见于2岁以内婴幼儿,志贺菌以夏秋季与脓血便检出率较高。(3)病原菌分离阳性腹泻标本pH>7占明显优势,轮状病毒阳性标本、病原检查阴性标本、健康体检对照标本pH<6占明显优势,前者pH与后三者pH统计学比较,差异有高度显著性(P<0.01)。结论引起小儿腹泻的病原种类繁多,轮状病毒居首位,内源性肠道条件致病菌在腹泻标本中的构成比已接近外源性肠道致病菌而成为腹泻的重要病原菌,大便pH可作为急性腹泻病早期简单、快速、准确、价廉的初步诊断及合理应用抗生素的重要指标。     

1988年大连市夏季成人感染性腹泻的病原学研究

本文对1988年7～10月大连市210例成人感染性腹泻病人进行了病原学的分离与鉴定。结果有138例患者的病原鉴定为阳性,病原检出率为65.7％(138/210)。在病原阳性的病例中有117例患者分离出病原菌,因此,我们认为夏季成人腹泻的主要病原是细菌(84.8％、117/138)。在致病菌中,副溶血弧菌最为多见,检出率最高(38.5％、45/117)。本研究表明,病毒感染虽不是夏季成人腹泻的主要致病因子,但在混合感染中,“病毒——细菌”混合感染占多数(66.7％、18/27)。     

2010-2013年上海长宁地区成人轮状病毒急性胃肠炎的分子特征

为研究上海长宁地区成人轮状病毒急性胃肠炎的分子特征,收集2010年6月-2013年12月长宁区定点医院成人急性胃肠炎患者的粪便标本1 554份,采用酶联免疫吸附试验(enzyme-linked immunosorbentassay,ELISA)进行A组轮状病毒检测,多重聚合酶链反应(polymerase chain reaction,PCR)进行B组和C组轮状病毒检测.结果显示,1 554例患者的平均年龄为(46.19±15.59)岁,其中男性691例、女性863例.共检出轮状病毒200株,检出率为12.87％.18～39岁组的轮状病毒检出率为9.15％,40～59岁组为15.58％,60～79岁组为15.16％,≥80岁组为18.57％.A组轮状病毒基因型检测结果显示,G型以G9亚型最多(29.82％),P型以P[8]亚型最多(77.19％),GP组合以G9P[8]最多(25.73％).结果提示,2010-2013年上海长宁地区成人轮状病毒急性胃肠炎在就诊患者中以中老年多见,基因型以G9P[8]最多.     

大连地区感染性腹泻病原监测结果分析

目的 了解大连地区感染性腹泻病原菌的种类和流行特征,为感染性腹泻的预防控制和临床治疗提供依据.方法 采用常规粪便培养方法,对分离菌做血清学分型,用MicroScan WalkAway-40全自动细菌鉴定及药敏分析仪对分离菌做生化鉴定,对检出的志贺菌做药敏试验,并用WHONET 5.4软件对药敏结果进行统计分析.结果 监测872例腹泻患者样本,检出感染性腹泻病原菌109株,阳性率为12.5％,其中志贺菌所占比例最大,其次为沙门菌,副溶血弧菌排第三.志贺菌对碳青霉烯类、氟喹诺酮类和头孢菌素类等敏感,对青霉素类和复方磺胺类耐药.结论 志贺菌是大连地区感染性腹泻的首要病原菌,沙门菌和副溶血弧菌次之,应依据此监测结果做好大连地区腹泻病的防治工作;同时根据耐药性监测结果合理使用抗生素应对志贺菌,减少耐药菌株出现.     

210株肠道致病菌的分类及耐药性分析

目的：探讨本地区肠道致病菌的分类及主要致病菌的耐药性,给临床治疗腹泻疾病提供指导。方法：药敏试验采用K-B法,用WHONET4软件进行数据分析。结果：210株肠道致病菌中,志贺菌属占70％,沙门菌属占3％,致病性大肠埃希菌占4．8％,副溶血弧菌占3．8％,阴沟肠杆菌占3．3％,鼠伤寒沙门菌占2．4％,霍乱弧菌占1．9％,其他占10．8％等;在志贺菌属中,福氏占87％,宋内占13％。福氏和宋内志贺菌对三代头孢和IMP较敏感,对复方新诺明耐药率较高。结论：福氏志贺菌是肠道的主要致病菌;临床怀疑菌痢时,应首选三代头孢、IMP。     

Epidemiological study on Jordanian patients suffering from diarrhoea

Stool specimens from 1400 Diarrhoeal patients from the Jordanian population were examined for bacterial pathogens and Rotavirus during a four- year period (1997-2000). Pathogenic bacteria were identified in 343 patients (24.5%), most often from children. Salmonella spp. was the most frequent isolated organism in 10.7% of the patient's cultures, followed by enteropathogenic Escherichia coli (EPEC) in 3.9%, Shigella spp. in 0.8% and Campylobacter spp. in 0.9%. Vibrio spp. was not identified in the stools tested. Resistance to ampicillin was observed in 42.2% of the Salmonella, 77.0% of the Shigella, and 31.0% of the EPEC isolates. Cotrimoxazole resistance was observed in 34.0% of the Shigella and 13.0% of the EPEC isolates and 77.0% of Campylobacter isolates. Rotavirus was identified in 373 samples (26.6%) of the patients     

Enteropathogens associated with acute diarrhea in community and hospital patients in Jakarta,Indonesia

The prevalence of bacteria, parasite and viral pathogens in 3875 patients with diarrhea in community and hospital settings from March 1997 through August 1999 in Jakarta, Indonesia was determined using routine bacteriology and molecular assay techniques. Bacterial pathogens isolated from hospital patients were, in decreasing frequency, Vibrio cholerae O1, Shigella flexneri, Salmonella spp. and Campylobacter jejuni, while S. flexneri, V. cholerae O1, Salmonella spp. and C. jejuni were isolated from the community patients. V. cholerae O1 was isolated more frequently (P<0.005) from the hospital patients than the community patients. Overall, bacterial pathogens were isolated from 538 of 3875 (14%) enrolled cases of diarrhea. Enterotoxigenic Escherichia coli were detected in 218 (18%) of 1244 rectal swabs. A small percentage of enterohemorrhagic E. coli (1%) and of Clostridium difficile (1.3%) was detected. Parasitic examination of 389 samples resulted in 43 (11%) positives comprising Ascaris lumbricoides (1.5%), Blastocystis hominis (5.7%), Giardia lamblia (0.8%), Trichuris trichiura (2.1%) and Endolimax nana (0.5%). Rotavirus (37.5%), adenovirus (3.3%) and Norwalk-like virus (17.6%) were also detected. Antimicrobial resistance was observed among some isolates. Bacterial isolates were susceptible to quinolones, with the exception of some isolates of C. jejuni which were resistant to ciprofloxacin, nalidixic acid and norfloxacin. Data obtained from this community- and hospital-based study will enable the Indonesian Ministry of Health to plan relevant studies on diarrheal diseases in the archipelago.     

Enteropathogens associated with diarrheal disease in infants of poor urban areas of Porto Velho, Rondônia: a preliminary study

One hundred and thirty cases of diarrhea and 43 age-matched controls, 0 to 5 years old, were studied in a pediatric outpatient unit from a poor peri urban area of Porto Velho, Rond?nia. Eighty percent of diarrheal cases were observed in the groups under 2 years of age. Rotavirus (19.2%) was the most frequent enteropathogen associated with diarrhea, followed by Shigella flexneri (6.15%) and S. sonnei (1.5%) and Salmonella sp. (6.9%). Four cases of E. coli enterotoxigenic infections (3.1%), E. coli enteropathogenic (EPEC)(2.3%) one case of E. coli enteroinvasive infection (0.8%) and one case of Yersinia enterocolitica (0.8%) were also identified. Mixed infections were frequent, associating rotavirus, EPEC and Salmonella sp. with Entamoeba histolytica and Giardia lamblia.     

A study of enteropathogenic organisms isolated in the public health laboratory, Lusaka.

A total of 328 specimens of stools were examined in the Public Health Laboratory during January and February 1973. Enteropathogens were isolated from 117 of these specimens. Besides these, 12 strains of Salmonellae were isolated from blood and 8 from urine. An occasional Salmonella was isolated from the pleural fluid (S. paratyphi A) pus from the knee (S. enteritidis) and from the C.S.F. of an infant (S. paratyphi C.). Salmonella typhi and Salmonella paratyphi A are the predominant Salmonella species. No Salmonella paratyphi B has been isolated. Shigella, was isolated with slightly less frequency than Salmonella, and Shigella flexneriis was the predominant species. E. coli 0112/K66 is the most common enteropathogenic E. coli. The majority of the Shigella and Salmonella species are sensitive to the common antibiotics used. The E. coli organisms show multiple resistance to a number of antibiotics.     

2009~2012年黑龙江省细菌性腹泻症候群病原菌检测结果分析

为了解黑龙江省细菌性腹泻病原谱构成,探讨主要病原体的变异和流行变迁规律,提高监测实验室腹泻病原实验室诊断、监测预警、突发细菌性腹泻疫情的处置能力,并为进一步防治工作提供科学依据。收集哨点医院肠道门诊的细菌感染性腹泻患者粪便,采用分离培养、生化鉴定和血清分型的方法,检测沙门氏菌、志贺氏菌、致泻大肠杆菌等肠道致病菌。检测细菌性腹泻症候群患者标本537份,检出率为36.69%,其中,主要致病菌为致泻性大肠杆菌、志贺氏菌、副溶血弧菌、沙门氏菌、类志贺邻单胞菌、嗜水气单胞菌、小肠结肠炎耶尔森菌、霍乱弧菌、空肠弯曲菌、大肠埃希氏菌、检出率分别为9.31%、6.89%、1.30%、3.35%、0.56%、0.19%、0.37%、0.74%、5.40%、16.95%;性别差异不显著,各年龄组病原菌检出率和各月病原菌检出率差异显著,病原菌检出率存在季节性差异,其中6、7、8、9月份病原菌检出率高,检出率之和占总检出率的93.40%,0～10岁年龄组患病人数和检出率均高于其他年龄组。 分析发现:黑龙江省夏秋两季是细菌感染性腹泻高发季节,主要致病菌为大肠杆菌埃希氏菌、志贺氏菌、沙门氏菌、空肠弯曲菌。     

2002年至2007年太原地区儿童细菌性腹泻病原菌分布及耐药分析

目的了解太原地区近6年儿童细菌性腹泻病原菌分布及耐药情况。方法对临床诊断细菌性腹泻病,便培养已分离到病原菌1080例作回顾性分析,分析其病原菌的分布及耐药情况。结果埃希菌属486株（45％）,居于首位,前5位的病原菌依次为埃希菌属、肠球菌属、酵母样真菌、志贺菌属、假单胞菌属。各年均以大肠埃希菌为主要检出菌,志贺菌逐年减少。年龄分布中,婴儿的构成比最高（44．4％）。埃希菌属、志贺菌属、假单胞菌属、沙门菌属、气单胞菌属此5种杆菌对13种抗生素的平均耐药率依次为舒普深、痢特灵、头孢他啶、庆大霉素、环丙沙星、头孢哌酮、头孢曲松、丁胺卡那、头孢噻肟、诺氟沙星、头孢呋辛、哌拉西林、头孢唑啉。从埃希菌属近6年的耐药性变迁资料可以看出,对13种抗生素的耐药率均有不同程度上升。结论传统的致病菌志贺菌属、沙门菌属较少,而肠球菌属、假单胞菌属、枸橼酸杆菌属、克雷伯杆菌属、肠杆菌属、酵母样真菌等条件致病菌肠炎占有相当比例。各种致病菌的耐药性增加,第三代头孢除头孢他啶的耐药率较低外,其余都较高。提示应严格掌握抗生素用药指证,合理选用抗生素。     

食源性相关腹泻肠炎沙门菌感染抗菌药物敏感性

目的了解食源性相关腹泻非伤寒沙门菌感染的菌种分布及其对抗菌药物敏感性,为控制该类细菌的感染及传播提供技术支持。方法对2015-2017年本系统2家社区卫生服务中心就诊的食源性相关腹泻患者粪便(或肛拭子)标本采用直接分离与增菌分离相结合的方法常规培养分离获得42株沙门菌;采用血清凝集法进行快速血清分型,并进行自动化生化鉴定及抗菌药物敏感性试验;通过现况调查进行流行病学危险因素分析。结果自动化生化鉴定结果能够覆盖常规血清学快速鉴定结果,同属沙门菌群;42株沙门菌以肠炎沙门菌、鼠伤寒沙门菌和斯坦利沙门菌为主,其中肠炎沙门菌占全部菌株的23.81%,鼠伤寒沙门菌占19.06%,斯坦利沙门菌占14.29%;其中肠炎沙门菌可对氟喹诺酮类、三四代头孢菌素类与碳青霉烯类等敏感(敏感率可达97.00%以上),而对氨基糖苷类可产生双向耐药。通过现况调查,发现患者有腹痛、腹泻等胃肠道症状,可伴有发热,所有患者48h内有可疑食物暴露史,无水源性案例,均为散发。结论菌种鉴定应以常规快速血清学凝集结果为准,自动化生化鉴定仅供参考,并将鉴定菌种与药敏报告相关联,可根据药敏结果合理选用敏感抗菌药物;应对社区居民开展针对性的健康宣教。     

内生贝莱斯芽胞杆菌生物拮抗活性的研究

目的研究内生菌的生物拮抗活性。方法基于植物贴片法、形态学与分子生物学特征等分离、鉴定内生菌;利用纸片扩散法检测分离株拮抗病原性细菌、植物部分内生菌及耐药性细菌的生物活性。结果分离株HBB5的菌落呈乳白色、黏液性、皱褶状凸起,镜下见革兰阳性、单个或成双或短链状排列杆菌;序列分析显示,HBB5菌的16SrRNA基因序列与GenBank数据库中贝莱斯芽胞杆菌(Bacillus velezensis)同源性为100%,鉴定为B.velezensis HBB5。拮抗试验显示,B.velezensis HBB5抑制Staphylococcus aureus、Enterococcus faecalis、Escherichia coli、Salmonella typhi、Salmonella paratyphi A、Shigella dysenteriae、内生Penicillium HBF3及Klebsiella ornithinolytica B1645-1等菌株生长,其与内生B.subtilis SWB8无明显抑制现象。结论首次从盾叶薯蓣植物中分离出Bacillus velezensis,其显示了广谱的抗病原细菌活性及一定的拮抗耐药菌的能力,可能参与宿主植物疾病的防御。     

Campylobacteriosis, salmonellosis, and shigellosis in free-ranging human-habituated mountain gorillas of Uganda

For conservation purposes and due to growing ecotourism, free-ranging mountain gorillas (Gorilla gorilla beringei) have been habituated to humans. Fecal specimens (n = 62) collected in January 1999 from mountain gorillas of the Bwindi and Mgahinga National Parks, Uganda, were tested for Campylobacter spp., Salmonella spp., and Shigella spp., and the overall prevalence of infection was 19%, 13%, and 6%, respectively. The prevalence of positive specimens was not related to the year of habituation of a gorilla group to humans. Campylobacter spp., Salmonella, and Shigella spp. infections were not distributed equally among the age classes of gorillas; most of the enteropathogens (80%), and all Shigella spp. organisms, S. sonnei, S. boydii, and S. flexneri, were isolated from subadults and adult gorillas with ages ranging from 6.0 to 11.9 yr. The prevalence of Campylobacter spp. and Salmonella spp. infections among human-habituated gorillas has doubled during the last 4 yr, and isolation of Shigella spp. for the first time from mountain gorillas, may indicate enhanced anthropozoonotic transmission of these enteropathogens.