腹泻儿童病例病原学检出情况及其特征

doi:10.12183/j.scjpm.2021.0284

摘要/Abstract

摘要： 目的分析腹泻儿童病例病原学检出情况及其特征,为儿童腹泻防治工作提供借鉴资料。方法以2018年9月至2020年9月琼海市某医院诊治的腹泻儿童为研究对象,进行资料收集,并收集病例粪便样本进行细菌鉴定、病毒抗原监测及药敏试验,采用描述流行病学分析方法进行分析。结果 1 059例腹泻儿童纳入研究,男童（59.0%）多于女童（41.0%）,以1~3岁儿童比例最高（57.0%）,夏秋季节发病比例高（63.2%）,临床症状主要有大便次数增多、大便稀薄,部分患儿伴有呕吐、脱水等。检出病原体617例,检出率为58.3%。不同年龄、发病季节的儿童病例病原体检出率差异均有统计学意义（P<0.05或P<0.01）,1~3岁（61.4%）、夏季（64.0%）发病的儿童病例病原体检出率更高。共检出病原体793株,其中病毒421株（53.1%）、细菌372株（46.9%）,病毒病原体中以轮状病毒（27.2%）、杯状病毒（12.9%）为主,细菌病原体中以沙门菌（19.8%）、志贺菌（13.9%）为主。沙门菌、志贺菌均对氨苄西林、头孢唑林、青霉素耐药性较高,而对亚胺培南、头孢他啶、庆大霉素耐药性较低。结论腹泻儿童病例男童、1~3岁儿童比例高,夏季发病比例高,病毒病原体中以轮状病毒、杯状病毒为主,细菌病原体中以沙门菌、志贺菌为主,需根据病原体分布特点及药敏试验结果合理用药,提高治疗效果。

关键词: 腹泻, 儿童, 病原学, 病原体, 耐药性

Abstract: Objective To observe the etiological detection and characteristics of children with diarrhea and provide reference for prevention and treatment of diarrhea in children. Methods The data of children with diarrhea treated in a hospital in Qionghai City from September 2018 to September 2020 were collected, and the fecal specimens of children were taken for bacterial identification, virus antigen monitoring and drug sensitivity test. Descriptive epidemiological analysis was used to analyze. Results A total of 1 059 children with diarrhea were included in the study. The proportion of boys （59.0%） was higher than that of girls （41.0%）, and the proportion of children aged 1-3 years was the highest （57.0%）. The incidence of diarrhea was higher in summer and autumn （63.2%）. The main clinical symptoms were increased stool frequency and thin stool. Some children were accompanied by vomiting and dehydration. Six hundred and seventeen cases of pathogen were detected, and the detection rate was 58.3%. There were statistically significant differences in the detection rate of pathogen among children with different ages and seasons （P<0.05 or P<0.01）. The detection rate of pathogen was higher in children aged 1-3 years （61.4%） and in summer （64.0%）. A total of 793 strains of pathogens were detected, including 421 strains of viruses （53.1%） and 372 strains of bacteria （46.9%）. Rotavirus （27.2%） and Calicivirus （12.9%） were the main viral pathogens, and Salmonella （19.8%） and Shigella （13.9%） were the main bacterial pathogens. Salmonella and Shigella had higher resistance to ampicillin, cefazolin and penicillin, but lower resistance to imipenem, ceftazidime and gentamicin. Conclusion The proportion of diarrhea cases in children is high in boys and children aged 1-3 years, and the incidence is high in summer. Rotavirus and Calicivirus were the main viral pathogens, and Salmonella and Shigella were the main bacterial pathogens. The rational drug use should be based on the distribution characteristics of pathogens and the results of drug sensitivity test to improve the therapeutic effect.

Key words: Diarrhea, Children, Etiology, Pathogen, Drug resistance

中图分类号:

R179

潘先莉, 李敏, 王文慧, 占达丽. 腹泻儿童病例病原学检出情况及其特征[J]. 华南预防医学, 2021, 47(3): 284-287.

PAN Xian-li, LI Min, WANG Wen-hui, ZHAN Da-li. Etiological detection and characteristics of children with diarrhea[J]. South China Journal of Preventive Medicine, 2021, 47(3): 284-287.

参考文献 23

[1]	中华医学会儿科学分会消化学组,《中华儿科杂志》编辑委员会.中国儿童急性感染性腹泻病临床实践指南[J].中华儿科杂志,2016,54(7):483-488.
[2]	GBD 2016 Diarrhoeal Disease Collaborators.Estimates of the global,regional,and national morbidity,mortality,and aetiologies of diarrhoea in 195 countries:A systematic analysis for the Global Burden of Disease Study 2016BD 2016 Diarrhoeal Disease Collaborators.Estimates of the global,regional,and national morbidity,mortality,and aetiologies of diarrhoea in 195 countries:A systematic analysis for the Global Burden of Disease Study 2016[J].Lancet Infect Dis,2018,18(11):1211-1228.
[3]	唐琼,龙毅,杨丽娜.5岁以下儿童腹泻影响因素研究进展[J].中国公共卫生,2020,36(7):1109-1112.
[4]	张扬,全淑燕,曾力楠,等.全球现有儿童腹泻临床实践指南的循证评价[J].中国药房,2018,29(8):1109-1116.
[5]	国家卫生健康委办公厅,国家中医药管理局办公室.儿童急性感染性腹泻病诊疗规范(2020年版)[J].全科医学临床与教育,2020,18(11):964-967.
[6]	胡灿,姚光海,黄艳萍,等.2005—2018年贵州省5岁以下儿童其他感染性腹泻流行特征分析[J].现代预防医学,2020,47(1):57-61.
[7]	王卫平,孙锟,常立文.儿科学[M].9版,北京:人民卫生出版社,2018:226-233.
[8]	叶应妩,王毓三,申子瑜.全国临床检验操作规程[M].3 版.南京:东南大学出版社,2006:715-923.
[9]	Gona PN,Gona CM,Chikwasha V,et al.Oral rehydration solution coverage in under 5 children with diarrhea:A tri-country,subnational,cross-sectional comparative analysis of two demographic health surveys cycles[J].BMC Public Health,2020,20(1):1716.
[10]	Khairy RMM,FathyZA,Mahrous DM,et al.Prevalence,phylogeny,and antimicrobial resistance of Escherichia coli pathotypes isolated from children less than 5?years old with community acquired-diarrhea in Upper Egypt[J].BMC Infect Dis,2020,20(1):908.
[11]	孙春涛,盛优静.儿童细菌性腹泻54例病原微生物检验情况及药敏结果分析[J].宁夏医学杂志,2020,42(2):162-163.
[12]	王维钧,舒高林,彭华,等.北京市昌平区感染性腹泻标本常见病原菌谱分析[J].实用预防医学,2019,26(10):1274-1277.
[13]	杨斐.不同年龄段腹泻儿童病原微生物检测结果分析[J].临床合理用药杂志,2015,8(6):101-102.
[14]	吕秋艳,李龙建,刘海涛,等.2013—2017年北京市门头沟区感染性腹泻病原菌监测结果分析[J].疾病监测,2019,34(6):42-46.
[15]	龚春华,刘芳,陈敏,等.2015—2016年上海三林地区儿童腹泻病原谱监测分析[J].实用预防医学,2018,25(7):124-127.
[16]	长三角免疫规划一体化项目组,中华医学会感染病学分会儿童感染和肝病学组.儿童轮状病毒胃肠炎预防诊疗专家共识(2020年版)[J].中华预防医学杂志,2020,54(4):392-405.
[17]	张立双,刘亭亭,王雪.北京市西城区5岁以下儿童病毒性腹泻影响因素分析[J].华南预防医学,2019,45(6):565-567.
[18]	韩亦非,高洁,魏建军,等.陕西省汉中市轮状病毒和诺如病毒感染性腹泻监测结果[J].中国热带医学,2020,20(8):731-734,742.
[19]	罗亮,王雪红,刘春平,等.深圳市坪山区2016—2017年病毒性腹泻监测结果分析[J].华南预防医学,2018,44(6):552-555.
[20]	吉彦莉,王永全,崔海洋,等.2015—2018年北京市西城区5岁以下儿童病毒性腹泻流行病学特征[J].公共卫生与预防医学,2020,31(3):104-107.
[21]	陈岗,郭红,蒋军,等.腹泻患儿粪便中病原微生物的检验及意义[J].检验医学与临床,2020,17(4):555-558.
[22]	赵会海,张盼,张海谱,等.肠道致病菌中志贺菌和沙门菌的分布及耐药性分析[J].海南医学,2020,31(3):295-298.
[23]	胡玲,王宝香,梅红,等.小儿感染性腹泻临床特征与病原菌分布及耐药性分析[J].中华医院感染学杂志,2019,29(14):2237-2240.