博茨瓦纳哈博罗内肠病原体的流行病学综述：HIV 流行地区耐药模式的变化。
An epidemiologic review of enteropathogens in Gaborone, Botswana: shifting patterns of resistance in an HIV endemic region.
机构信息
Botswana-UPenn Partnership, Gaborone, Botswana.
出版信息
PLoS One. 2010 Jun 2;5(6):e10924. doi: 10.1371/journal.pone.0010924.
BACKGROUND
The epidemiology of diarrheal disease in Botswana, an HIV endemic region, is largely unknown. Our primary objective was to characterize the prevalent bacterial and parasitic enteropathogens in Gaborone, Botswana. Secondary objectives included determining corresponding antimicrobial resistance patterns and the value of stool white and red blood cells for predicting bacterial and parasitic enteropathogens.
METHODOLOGY/PRINCIPAL FINDINGS: A retrospective cross-sectional study examined laboratory records of stool specimens analyzed by the Botswana National Health Laboratory in Gaborone, Botswana from February 2003 through July 2008. In 4485 specimens the median subject age was 23 [interquartile range 1.6-34] years. Overall, 14.4% (644 of 4485) of samples yielded a pathogen. Bacteria alone were isolated in 8.2% (367 of 4485), parasites alone in 5.6% (253 of 4485) and both in 0.5% (24 of 4485) of samples. The most common bacterial pathogens were Shigella spp. and Salmonella spp., isolated from 4.0% (180 of 4485) and 3.9% (175 of 4485) of specimens, respectively. Escherichia coli (22 of 4485) and Campylobacter spp. (22 of 4485) each accounted for 0.5% of pathogens. Comparing antimicrobial resistance among Shigella spp. and Salmonella spp. between two periods, February 2003 to February 2004 and July 2006 to July 2008, revealed an increase in ampicillin resistance among Shigella spp. from 43% to 83% (p<0.001). Among Salmonella spp., resistance to chloramphenicol decreased from 56% to 6% (p<0.001). The absence of stool white and red blood cells correlated with a high specificity and negative predictive value.
CONCLUSIONS/SIGNIFICANCE: Most gastroenteritis stools were culture and microscopy negative suggesting that viral pathogens were the majority etiologic agents in this Botswana cohort. Shigella spp. and Salmonella spp. were the most common bacteria; Isospora spp. and Cryptosporidium spp. were the most common parasites. Resistance to commonly used antimicrobials is high and should be closely monitored.
背景
博茨瓦纳是艾滋病毒流行地区，腹泻病的流行病学情况尚不清楚。我们的主要目标是描述博茨瓦纳哈博罗内地区流行的细菌性和寄生虫性肠道病原体。次要目标包括确定相应的抗菌药物耐药模式以及粪便白细胞和红细胞对预测细菌性和寄生虫性肠道病原体的价值。
方法/主要发现：对博茨瓦纳国家卫生实验室 2003 年 2 月至 2008 年 7 月期间分析的哈博罗内粪便标本的实验室记录进行了回顾性横断面研究。在 4485 例标本中，中位年龄为 23 岁[四分位间距 1.6-34]。总体而言，14.4%（4485 例中有 644 例）的样本检出病原体。单独分离出细菌占 8.2%（4485 例中有 367 例），单独分离出寄生虫占 5.6%（4485 例中有 253 例），两者均占 0.5%（4485 例中有 24 例）。最常见的细菌性病原体是志贺氏菌属和沙门氏菌属，分别从 4.0%（4485 例中有 180 例）和 3.9%（4485 例中有 175 例）的标本中分离出来。大肠杆菌（4485 例中有 22 例）和弯曲菌属（4485 例中有 22 例）各占 0.5%的病原体。比较 2003 年 2 月至 2004 年 2 月和 2006 年 7 月至 2008 年 7 月期间志贺氏菌属和沙门氏菌属之间的抗菌药物耐药性，发现志贺氏菌属的氨苄西林耐药率从 43%增加到 83%（p<0.001）。沙门氏菌属对氯霉素的耐药性从 56%下降到 6%（p<0.001）。粪便白细胞和红细胞缺失与高特异性和阴性预测值相关。
结论/意义：大多数胃肠炎粪便培养和显微镜检查均为阴性，提示病毒病原体是博茨瓦纳队列的主要病原体。志贺氏菌属和沙门氏菌属是最常见的细菌；等孢子球虫属和隐孢子虫属是最常见的寄生虫。常用抗菌药物的耐药率很高，应密切监测。
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