| 摘要: |
| [摘要] 目的 了解 2022-2025年桂林市儿童感染性腹泻病原学的构成和流行特征，为本地区儿童腹泻病治疗及防控提供依据。 方法 收集2022年3月至 2025 年3月在桂林市某医院就诊的腹泻病例相关信息，采集粪便标本进行病原学(5种病毒、6类致病菌)检测。细菌分离按常规培养与鉴定，病毒检测采用聚合酶链式反应（PCR）方法。对分离的沙门菌与致泻性大肠埃希菌（diarrheagenic Escherichia coli，DEC））进行药敏试验及部分沙门菌株进行全基因组测序。统计学采用卡方检验或Fisher精确检验，P<0.05为差异有统计学意义。 结果 1186份检测样本中，检出病原体577例，总阳性检出率为 48.65%，细菌检出率为 15.77%（187/1186），病毒检出率为32.88%（390/1186），混合细菌-病毒检出率为 7.34%（87/1186），混合病毒-病毒检出率为 3.88%（46/1186），混合细菌-细菌检出率为 0.59%（7/1186）。 病原体在不同季节的检出率亦存在差异，轮状病毒在冬春季检出率高，沙门菌夏秋季检出率高，其差异具有统计学意义（P＜0.05）；不同年龄组阳性检出率的差异有统计学意义（P<0.05），以1-3岁儿童腹泻患者病原体阳性检出率最高。对63株沙门菌和49株DEC进行药敏试验，沙门菌对氨苄西林耐药率为73.01%、对头孢噻肟耐药率为38.10%、对复方新诺明耐药率为49.20%；DEC对应耐药率分别为59.18%、36.73%和32.65%。两者对替加环素、厄他培南、亚胺培南和美罗培南均敏感。对其中37株沙门菌进行全基因组测序，均检出氨基糖苷类耐药基因aac(6’)-Iaa，其次检出率较高的为β-内酰胺类耐药基因blaTEM-1B（26株，占比70.27%）和磺胺类耐药基因sul2（23株，占比62.16%）。49株DEC毒力基因检测结果显示，eae基因（EPEC）、aaiC基因（EAEC）为最常见基因。结论 桂林市儿童感染性腹泻呈现一定年龄特征及季节变化，病原谱具有区域性差异，在临床上需根据其特性制定相应治疗方案及防控措施。 |
| 关键词: 儿童 感染性腹泻 病原体特征 全基因组测序 毒力基因 |
| DOI： |
| 分类号: |
| 基金项目:广西卫生健康委员会科研课题项目(编号Z-C20231627) |
|
| Analysis of pathogen Characteristics in Children with Infectious Diarrhea at a Hospital in Guilin |
|
qinwenzhen
|
|
Guilin Maternal and Child Health HosPital
|
| Abstract: |
| [Abstract] Objective To investigate the etiological composition and epidemiological characteristics of infectious diarrhea among children in Guilin City from 2022 to 2025, providing a basis for the treatment and prevention of childhood diarrheal diseases in this region. Methods Information on diarrheal cases and stool samples were collected from children attending a hospital in Guilin between March 2022 and March 2025. Pathogen detection targeted 5 viruses and 6 categories of pathogenic bacteria. Bacterial isolation followed conventional culture and identification procedures, while viral detection utilized the Polymerase Chain Reaction (PCR) method. Antimicrobial susceptibility testing was performed on isolated Salmonella and diarrheagenic Escherichia coli (DEC) strains, and whole-genome sequencing was conducted on a subset of Salmonella isolates. Statistical analyses employed the Chi-square test or Fisher's exact test, with a P-value < 0.05 considered statistically significant. Results Of the 1,186 samples tested, pathogens were detected in 577 cases, resulting in an overall positive detection rate of 48.65%. The bacterial detection rate was 15.77% (187/1186), the viral detection rate was 32.88% (390/1186), and mixed bacterial–viral co-detection was observed in 7.34% (87/1186) of samples. The rates of virus–virus co-detection and bacterium–bacterium co-detection were 3.88% (46/1186) and 0.59% (7/1186), respectively. Pathogen detection rates varied significantly by season (P < 0.05): Rotavirus showed higher prevalence in winter and spring, whereas Salmonella was more common in summer and autumn. Detection rates also differed significantly across age groups (P < 0.05), with the highest positivity rate observed in children aged 1-3 years. Antimicrobial susceptibility testing of 63 Salmonella and 49 DEC isolates revealed the following resistance rates in Salmonella: ampicillin (73.01%), cefotaxime (38.10%), and trimethoprim-sulfamethoxazole (49.20%). Corresponding resistance rates in DEC were 59.18%, 36.73%, and 32.65%, respectively. All isolates remained susceptible to tigecycline, ertapenem, imipenem, and meropenem. Whole-genome sequencing of 37 Salmonella isolates identified the aminoglycoside resistance gene aac(6')-Iaa in all strains. Other prevalent resistance genes included the β-lactamase gene TEM-1B (26 strains, 70.27%) and the sulfonamide resistance gene sul2 (23 strains, 62.16%). Virulence gene profiling of 49 DEC isolates indicated that eae (typical of EPEC) and aaiC (typical of EAEC) were the most common genes detected. Conclusion Infectious diarrhea among children in Guilin exhibits distinct age-related and seasonal patterns, with a regional-specific pathogen profile. Clinical management and public health strategies should be tailored accordingly based on these characteristics. |
| Key words: Children Infectious Diarrhea Pathogen Characteristics Whole-Genome Sequencing Virulence Genes |
