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2021—2022年全国多中心沙门菌血清分型及耐药性分析

National Multicenter Analysis of Serotype Distribution and Antimicrobial Resistance of Salmonella in China, 2021—2022

    摘要
  • 摘要:
    目的  分析全国多中心临床分离的沙门菌血清型分布及耐药情况。
    方法  回顾性收集2021年1月1日至2022年12月31日全国26个省市/自治区的53所医院分离获得的非重复沙门菌菌株，采用质谱法对所有菌株进行复核，并采用血清凝集试验进行血清分型、微量肉汤稀释法进行药敏试验。
    结果  共纳入605株沙门菌，鉴定出42种血清型，其中鼠伤寒沙门菌(37.7%)和肠炎沙门菌(34.0%)为优势血清型。药敏结果显示，605株沙门菌对氨苄西林耐药率最高(80.8%)，对左氧氟沙星(8.8%)、亚胺培南(1.2%)、厄他培南(0.8%)和美罗培南(0.5%)的耐药率均低于10%。血清分型方面，鼠伤寒沙门菌对氨苄西林(88.6%)、环丙沙星(11.8%)、左氧氟沙星(7.5%)、氯霉素(52.6%)、头孢他啶(16.7%)、头孢曲松(32.9%)、米诺环素(62.3%)、复方新诺明(45.2%)的耐药率高于肠炎沙门菌。年龄方面，6~17岁人群分离株对氨苄西林/舒巴坦(59.1%)和米诺环素(45.5%)的耐药率较高，65岁以上人群分离株对亚胺培南(5.1%)和厄他培南(3.4%)的耐药率较高。标本类型方面，粪便来源菌株对氨苄西林(82.5%)、氯霉素(40.8%)、米诺环素(41.0%)和复方新诺明(37.8%)的耐药率高于其他标本来源。科室来源方面，血液内科分离株对左氧氟沙星的耐药率最高(22.2%)。地理区域方面，华中地区分离菌株对环丙沙星的耐药率最高(19.0%)，华南地区对氯霉素(59.6%)和米诺环素(59.6%)耐药率最高，华东地区对复方新诺明的耐药率最高(51.2%)。沙门菌总体多重耐药率为44.8%(271/605)。
    结论  我国临床分离的沙门菌血清型分布多样，以鼠伤寒沙门菌和肠炎沙门菌为主要优势型别，且整体耐药水平较高，多重耐药现象普遍。不同年龄、标本类型、科室及地区来源的菌株对常用抗菌药物的耐药率存在差异，临床应依据药敏结果合理选用抗菌药物，以减缓耐药性发展。

     

    Abstract:
    Objective  To analyze the distribution of serotypes and antimicrobial resistance of clinical Salmonella isolates from multiple centers across China.
    Methods  Non-duplicate Salmonella strains were retrospectively collected from 53 hospitals in 26 provinces between January 1, 2021, and December 31, 2022. All isolates were confirmed by mass spectrometry, with serotyping performed using serum agglutination tests and antimicrobial susceptibility testing conducted via the broth microdilution method.
    Results  A total of 605 Salmonella strains were included, comprising 42 serotypes. S.typhimurium (37.7%) and S.enteritidis (34.0%) were the predominant serotypes. Antimicrobial susceptibility testing revealed the highest resistance rate to ampicillin (80.8%), while resistance to levofloxacin (8.8%), imipenem (1.2%), ertapenem (0.8%), and meropenem (0.5%) was below 10%. In terms of serotype distribution, S.typhimurium exhibited higher resistance rates than S.enteritidis to ampicillin (88.6%), ciprofloxacin (11.8%), levofloxacin (7.5%), chloramphenicol (52.6%), ceftazidime (16.7%), ceftriaxone (32.9%), minocycline (62.3%), and trimethoprim-sulfamethoxazole (45.2%). By age group, isolates from individuals aged 6-17 years showed higher resistance to ampicillin-sulbactam (59.1%) and minocycline (45.5%), while those from patients over 65 years had higher resistance to imipenem (5.1%) and ertapenem (3.4%). Regarding specimen type, stool-derived isolates demonstrated higher resistance to ampicillin (82.5%), chloramphenicol (40.8%), minocycline (41.0%), and trimethoprim-sulfamethoxazole (37.8%) compared to other sources. Among departments, isolates from the hematology unit showed the highest resistance to levofloxacin (22.2%). Geographically, strains from Central China had the highest resistance to ciprofloxacin (19.0%), those from South China exhibited the highest resistance to chloramphenicol (59.6%) and minocycline (59.6%), and isolates from East China showed the highest resistance to trimethoprim-sulfamethoxazole (51.2%). The overall multidrug resistance rate among Salmonella isolates was 44.8% (271/605).
    Conclusions  Clinically isolated Salmonella strains in China display diverse serotype distributions, with S.typhimurium and S.enteritidis being the predominant types. High overall antimicrobial resistance and widespread multidrug resistance were observed. Resistance rates to commonly used antimicrobials varied by age, specimen type, department, and geographic region. Antimicrobial therapy should be guided by susceptibility testing results to mitigate the development of resistance.

     

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