Enteric Diseases Epidemiology Branch, Division of Foodborne, Bacterial and Mycotic Diseases, National Center for Zoonotic, Vectorborne and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329-4018, USA.
Pediatr Infect Dis J. 2009 Nov;28(11):976-80. doi: 10.1097/INF.0b013e3181a76eab.
Shigellosis outbreaks in daycare centers result in substantial disease and economic burdens in the United States. The emergence of multidrug resistant Shigella strains raises questions regarding control of transmission within daycare centers and treatment for children. From May to October 2005, 639 Shigella sonnei cases were reported in northwest Missouri, mostly among persons exposed to daycare centers.
We conducted a case-control investigation among licensed daycare centers (LDCs) in northwest Missouri to determine transmission risk factors, tested isolates for antimicrobial resistance, and described treatment practices. Case LDCs had secondary attack rates of shigellosis>or=2% (range, 2%-25%) and control LDCs<or=2% (range, 0%-1.3%). We interviewed LDC staff and performed on-site inspections. Thirty-one outbreak isolates were tested for antimicrobial resistance. We interviewed physicians and reviewed health department outbreak-related treatment data.
We enrolled 18 case and 21 control LDCs. LDCs with >or=1 sink in every room (odds ratio [OR]: 0.1; 95% confidence interval [CI]: 0.02-0.5) or a diapering station in every room (OR: 0.1; 95% CI: 0.01-0.6) were less likely to be case-LDCs. Resistance to ampicillin and trimethoprim-sulfamethoxazole was found in 90% of the outbreak strains. Among 210 children treated with antimicrobial agents, azithromycin was used in 92 (44%) while a fluoroquinolone was used in 11 (5%) children.
During a large daycare center-associated shigellosis outbreak, strains were highly resistant to ampicillin and trimethoprim-sulfamethoxazole. Children were frequently treated with azithromycin and occasionally fluoroquinolones. Appropriate handwashing and diapering infrastructure are necessary to minimize spread of shigellosis within daycare centers, and could reduce use of antimicrobial agents.
在美国，日托中心爆发的志贺氏菌病会导致严重的疾病和经济负担。多重耐药志贺氏菌菌株的出现引发了人们对日托中心内传播控制和儿童治疗的质疑。2005 年 5 月至 10 月，密苏里州西北部报告了 639 例宋内志贺氏菌病例，主要发生在接触日托中心的人群中。
我们对密苏里州西北部的持照日托中心（LDC）进行了病例对照调查，以确定传播的危险因素，测试分离株的抗药性，并描述治疗方法。病例日托中心的志贺氏菌二次攻击率>或=2%（范围，2%-25%），而对照组的 LDC<或=2%（范围，0%-1.3%）。我们采访了 LDC 工作人员并进行了现场检查。对 31 例暴发分离株进行了抗药性检测。我们采访了医生并回顾了卫生部门与暴发有关的治疗数据。
我们共招募了 18 例病例和 21 例对照 LDC。每个房间有>或=1 个水槽（比值比[OR]：0.1；95%置信区间[CI]：0.02-0.5）或每个房间有尿布台（OR：0.1；95%CI：0.01-0.6）的 LDC 不太可能成为病例 LDC。90%的暴发菌株对氨苄西林和磺胺甲恶唑耐药。在接受抗菌药物治疗的 210 名儿童中，92 名（44%）使用阿奇霉素，11 名（5%）儿童使用氟喹诺酮类药物。
在一次大规模的日托中心相关志贺氏菌病暴发中，菌株对氨苄西林和磺胺甲恶唑高度耐药。儿童经常使用阿奇霉素，偶尔使用氟喹诺酮类药物。适当的洗手和尿布基础设施是减少日托中心内志贺氏菌传播的必要条件，并可减少抗菌药物的使用。
