Yu Hua-li, Chang Zhao-rui, Zhang Li-shi, Zhang Jing, Li Zhen-jun, Xu Jian-guo, Ran Lu
School of Public Health, Sichuan University, Chengdu 610041, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2007 Apr;28(4):370-3.
The Ministry of Public Health released the National Surveillance project on Shigellosis in August, 2005. This study was to reveal the antimicrobial resistance status of Shigella isolates through the National Shigellosis Surveillance System in 2005 in China, so as to provide evidence for the development of surveillance, prevention and cure of Shigellosis.
All the lab assistants received training from Chinese Center for Disease Control and Prevention. The project prescribed the uniform experimentation, quality control method, reagent, etc. Disc diffusion test(K-B) was carried out, following the CLSI methods. Data were analyzed by WHONET 5.4 software.
(1) 3 serotypes were identified and S. flexneri was common that accounted for 75.5% of all Shigella isolates followed by 24.4% of S. sonnei, but only 1 strain of S. dysenteriae was separated. (2) The resistant rates to tetracycline and ampicillin in Shigella spp were quite high, as over 90.0%. However, the resistant rate to Cefotaxime was the lowest, only 6.1%. The resistant rates were different between serotypes with the resistant rates of S. flexneri to ampicillin, ampicillin/clavulanate and ciprofloxacin were higher than those of S. sonnei (P < 0.001). (3) The multiple-antibiotic-resistance status in Shigella spp was quite serious and the resistant rate to five and more antimicrobials was 54.9%. The most common resistant patterns were seen on ampicillin, nalidixin, tetracycline and sulfamethoxazole. (4) There were some differences in subtypes and antimicrobial resistance among different provinces.
Cefotaxime seemed the best in curing Shigellosis at the clinic level. Programs regarding monitoring subtypes and antimicrobial resistance of Shigella should be in a continuous manner so as to understand the pathogens timely and to control the disease pertinently.
2005年8月，卫生部发布了志贺菌病国家监测项目。本研究旨在通过2005年中国志贺菌病监测系统揭示志贺菌分离株的耐药状况，为志贺菌病的监测、预防和治疗提供依据。
所有实验室工作人员均接受了中国疾病预防控制中心的培训。该项目规定了统一的实验、质量控制方法、试剂等。采用纸片扩散法（K-B法），按照CLSI方法进行操作。数据用WHONET 5.4软件进行分析。
（1）共鉴定出3个血清型，福氏志贺菌最为常见，占所有志贺菌分离株的75.5%，其次是宋内志贺菌，占24.4%，仅分离到1株痢疾志贺菌。（2）志贺菌属对四环素和氨苄西林的耐药率相当高，超过90.0%。然而，对头孢噻肟的耐药率最低，仅为6.1%。不同血清型之间的耐药率存在差异，福氏志贺菌对氨苄西林、氨苄西林/克拉维酸和环丙沙星的耐药率高于宋内志贺菌（P<0.001）。（3）志贺菌属的多重耐药状况相当严重，对5种及以上抗菌药物的耐药率为54.9%。最常见的耐药模式为对氨苄西林、萘啶酸、四环素和磺胺甲恶唑耐药。（4）不同省份在亚型和抗菌药物耐药性方面存在一些差异。
在临床层面，头孢噻肟似乎是治疗志贺菌病的最佳药物。应持续开展志贺菌亚型和抗菌药物耐药性监测项目，以便及时了解病原体情况并针对性地控制疾病。
