小兒急診病童之非傷寒性沙門桿菌感染在中台灣地區流行病學與抗生素敏感性分析

Epidemiologic Analysis and Antimicrobial Susceptibility of Non-typhoidal Salmonellosis in Children in the Pediatric Emergency Department in Central Taiwan

林雅純(Ya-Chun Lin) ； 李振宜(Zan-Yei Li) ； 李敏駿(Min-Chun Lee) ； 吳漢屏(Han-Ping Wu)

《Journal of Emergency Medicine, Taiwan》 12卷2期 (2010/06) Pp. s14-s20

摘要

背景：非傷寒性沙門氏菌感染的病患在急診室仍具頗高的發生率。了解抗生素抗藥性和血清型分類可使臨床照顧者在照護病患時有所助益。本研究目的在確認中台灣地區非傷寒性沙門氏菌腸炎在小兒急診的盛行率及抗生素敏感測試之情況。
方法：本研究以回溯性分析2002年至2006年中台灣地區非傷寒型沙門氏桿菌感染而至急診室求診的病童。分析其臨床資料並進行人口統計、逐年盛行率、血清型分類，及抗生素敏感試驗。
結果：感染的高峰期在每年的7月至9月份。最常影響的年齡為1-6歲，其次為小於1歲。以糞便檢體分析，菌種比例統計出血清型B和D為最常見的菌種：Salmonella enteritidis B佔51.3%；D佔22.2%；C1佔11.3%；C2佔100%；E佔5.0%；sPP佔1.1%。而糞便檢體之桿菌抗生素敏感性分析顯示40.7%對Ampicilin有抗藥性；Doxycycline有(56.5%)抗藥性；trimethoprim-sulfamothoxazole則有(27.2%)。而來自血液檢體之桿菌發現其對ceftriaxone(95.5%)及ciprofloxacin(98.8%)有高度的敏感性。
結論：本研究提供急診醫師有關非傷寒性沙門桿菌感染在中台灣地區流行病學的資料，並且提供有關其抗生素抗藥性的分析。相信本研究對臨床醫師在面對細菌性腸炎時，將可提其供選擇抗生素的訊息。

關鍵字

流行病學 ； 非傷寒型沙門氏菌 ； 抗生素敏感性 ； 兒童 ； 中台灣地區

並列摘要

Background: Infection with Salmonella is a frequently reported cause of bacterial enterocolitis in children admitted to pediatric emergency department (ED). Understanding the antimicrobial susceptibility and the serotype of non-typhoidal Salmonella may be helpful for emergency physicians to approach children with bacterial enterocolitis. The aim of the study was to determine the prevalence of non-typhoidal Salmonellosis in children and evaluate antimicrobial susceptibility patterns of Salmonellosis in central Taiwan.
Methods: From 2002 to 2006, we retrospectively collected 966 cases, younger than 18 years, with positive non-typhoid culture for salmonella isolated. We further underwent the epidemiological analysis, including the demographic data, prevalence, and analysis of serotype and antimicrobial susceptibility in patients admitted to the pediatric ED.
Results: Non-typhoidal salmonella infection was highly frequent in children during the period from July to September. The most common affected age was children less than 7 years old (92.3%). Salmonella serotypes B and D were the 2 most pathogens isolated from stool culture. Salmonella enteritidis B caused 51.3% of episodes, followed by D (22.2%), C1 (11.3%), C2 (10.0%), E (5.0%), and spp (1.1%). Based on analysis of antimicrobial susceptibility, 40.7% of all isolates appeared resistant to ampicillin, 56.5% to doxycycline, and 27.2% to trimethoprim-sulfamethoxazole, but all isolates were highly susceptible to ceftriaxone (95.5%), and ciprofloxacin (98.8%).
Conclusion: The study may provide a key way to emergency physicians in decision making about appropriate antibiotics use in severe Salmonella infection. Different protocols of clinical approach and management are necessary for clinicians to treat children with bacterial enterocolitis based on our epidemiological analysis.

並列關鍵字

epidemiologic analysis ； non-typhoidal salmonellosis ； antimicrobial susceptibility ； children ； central Taiwan