Epidemiological Study of Human Salmonellosis during 1991-1996 in Southern Taiwan

1991-1996年南臺灣地區沙門氏桿菌感染病患之流行病學研究

陳彥旭(Yen-Hsu Chen) ； 陳田柏(Tyen-Po Chen) ； 蔡季君(Jih-Jin Tasi) ； 黃高彬(Kao-pin Hwang) ； 盧柏樑(Po-Lian Lu) ； 鄭孝胥(Hsiao-Hsu Cheng) ； 彭健芳(Chien-Fang Peng)

《The Kaohsiung Journal of Medical Sciences》 15卷3期 (1999/03) Pp. 127-136

https://doi.org/10.6452/KJMS.199903.0127

摘要

雖然近年來環境衛生已有大幅進步，但沙門氏桿菌一直是臨床上相當重要的致病菌，即使是美國一年仍有超過四萬個報告病例，臺灣地區亦不例外。本研究之目的是為了瞭解近年來南臺灣地區沙門氏桿菌感染之臨床及微生物學之特性。收集自1991年一月至1996年十二月期間，因罹患沙門氏桿菌感染而至高雄醫學院就診、住院之病患共249位，包括嬰幼兒與成人。記錄及分析其臨床資料並進行菌種之研究，包括血清型及抗藥性分析。這段期間內病患數逐年增加，由1991年14位增至1996年的79位，尤其是非傷寒型沙門氏桿菌之感染。經血清型之分析共有57種血清型出現於此期間，其中以為　S.typhimurium（41.8％）最多，其次分別是　S.choleraesuis（10％）、S.schwanzengrund（3.6％）、S.derby（3.2％）。臨床上，雖然發燒（81.1％）、腹瀉（68.9％）、厭食（44.6％）是病患最常見之表徵，但不同血清型感染所產生之症狀仍有差異，相對性緩脈較常見於S.typhi造成之感染。但血球增多，尤其是淋巴球之增加，較常見於非傷寒性沙門氏桿菌感染之病患。肝功能異常則較常見於S.choleraesuis；　S.typhi所造成之侵入性感染。關於病人之在疾病方面，最常見的是惡性腫瘤（8.8％），尤其是血液方面之癌症（5.2％），及腸胃道疾病（8.8％），其次為糖尿病（6.4）。整體死亡率為8％，其中以S.choleraesuis之感染所造成之死亡率最高，這可能和此類病患潛在疾病較嚴重有關。沙門氏桿菌之抗藥性在南臺灣相當嚴重，尤其是非傷寒性沙門氏桿菌，對臨床上常用之抗生素產生相當高的抗藥比率。對ampicillin、chloramphenicol、TMP/SMZ之整體抗樂比率分別高達67.9％、66.8％、32.2％。此外，有相當多之菌株產生多重抗藥性，造成治療之困難。在研究期間，我們亦分別在1994、1995年於鄱便檢體分離出兩株S.schwanzengrund，其對最新發明之fluoroquinolone類抗微生物製劑產生交叉抗藥性，包括ofloxacin、ciprofloxacin、lomefloxacin，這將造成治療上另一個嚴重問題。至於南臺灣嚴重抗藥性之產生與畜牧業濫用抗生素之因果關係則有待進一步之研究。

並列摘要

Within a 6-year period from January 1991 to December 1996, 249 patients of salmonellosis admitted to Kaohaiung Medical College Hospital were enrolled for climical and microbiological analysis. The number of patients increased by year from 1991 (14 patients) to 1996 (79 patients), especially in the case of nontyphoid salmonellosis. There were 57 different serotypes isolated during these period. Salmonella typhimurium was the most common clinical serotype of human origin in southern Taiwan, followed by S. choleraesuis, S. schwanzengrund, and S. derby. Fever (81.1%). Diarrhea (68.9%), and anorexia (44.6%) were the most common manifestations of human salmonellosis. Relative bradycardia was a more important feature in S. typhigroup (100%) than nontyphoid salmonellosis. Leukocytosis, especially lymphocytosis, was found especially in nontyphoid, but not in typhoid salmonellosis. Elevated liver function tests were found in the most severe patients, such as S. choleraesuis and S. typhi infections. Malignancy (8.8%), especially hematological malignancy(5.2)%, gastrointestinal diseases (8.8%), and diabetes mel;otis (6.4%) were the common underlying diseases. Case fatality rate of human salmonellosis was 8% (20/249), especially high in S.choleraesuis group. The severity of underlying diseases may be the major cause in S. choleraesuis group. There was no fatal case with typhoid fever. Very high resistance rate to commonly used antimicrobial agents in nontyphoid Salmnella was noted in southern Taiwan with overall rates of resistance to ampicillin, 67.9%, chloramphenicol, 66.7%, and TMP/SMZ, 42.2%, The emergence of ciprofloxacin – resistant and multiresistant strains was also a major therapeutic problem in this study.

並列關鍵字

salmonellosis ； serotypes ； antimicrobial ； resistance