Gyem Kinley, Pelden Sonam, Tshering Dorji, Penjor Kinley, Wangchuk Rinzin, Dorji Sangay, Tenzin Jigme, Phuyel Birdi Lal
Enteric Zoonotic and Vector-Borne Disease Laboratory, Royal Centre for Disease Control, Thimphu, Bhutan
Enteric Zoonotic and Vector-Borne Disease Laboratory, Royal Centre for Disease Control, Thimphu, Bhutan.
BMJ Open. 2025 Jan 6;15(1):e086332. doi: 10.1136/bmjopen-2024-086332.
This study aimed to identify the aetiological spectrum, seasonal distribution and antimicrobial resistance patterns of diarrhoeal diseases in Bhutan.
The study used a cross-sectional, retrospective analysis of secondary data gathered through a passive, hospital-based sentinel surveillance for diarrhoeal disease across 12 hospitals, representing Bhutan's demographically diverse regions.
A total of 3429 participants' data of all age groups who presented with diarrhoea at sentinel hospitals between 1 January 1 2016 and 31 December 2022 were analysed.
Diarrhoeagenic (DEC), , and spp. were predominant bacterial pathogens, while and were the leading viral pathogens. Coinfections were observed in 195 cases. Children under nine were significantly affected than the other age groups. Seasonal trends revealed that bacterial pathogen incidence peaked during the summer/monsoon season, viral pathogens were more common in winter and spring, and parasites persisted year-round. Among the antibiotics tested, gentamicin, chloramphenicol, ceftriaxone and tetracycline exhibited high efficacy, with susceptibility rates of 93.4%, 87.2%, 81.5% and 69.5%, respectively. Conversely, high resistance rates were observed for amoxicillin (80.3%), ampicillin (77.4%) and nalidixic acid (69.5%). Multidrug resistance was prevalent, with β-lactamase production contributing to resistance rates of 80.7% to penicillin and 65.4% to fluoroquinolones groups. Cephalosporin resistance was also notable, with rates of 34.4% for cephalexin, 40.0% for cefazolin and 16.9% for ceftriaxone.
DEC and were identified as the leading causes of diarrhoea, with significant resistance patterns observed in common bacterial isolates. These findings underscore the need for DEC screening in paediatric cases and emphasise the need for sustained antimicrobial resistance surveillance.
本研究旨在确定不丹腹泻病的病因谱、季节分布和抗菌药物耐药模式。
本研究采用横断面回顾性分析，对通过基于医院的被动哨点监测收集的二次数据进行分析，该监测覆盖不丹12家医院，代表了该国人口结构多样的地区。
分析了2016年1月1日至2022年12月31日期间在哨点医院出现腹泻症状的所有年龄组的3429名参与者的数据。
致腹泻性大肠埃希菌（DEC）、志贺菌属、沙门菌属和弯曲菌属是主要的细菌病原体，而轮状病毒和诺如病毒是主要的病毒病原体。共观察到195例合并感染。9岁以下儿童受影响的程度明显高于其他年龄组。季节趋势显示，细菌病原体发病率在夏季/季风季节达到峰值，病毒病原体在冬季和春季更为常见，寄生虫全年都有。在所测试的抗生素中，庆大霉素、氯霉素、头孢曲松和四环素显示出较高的疗效，敏感率分别为93.4%、87.2%、81.5%和69.5%。相反，阿莫西林（80.3%）、氨苄西林（77.4%）和萘啶酸（69.5%）的耐药率较高。多重耐药很普遍，β-内酰胺酶的产生导致对青霉素组的耐药率为80.7%，对氟喹诺酮组的耐药率为65.4%。头孢菌素耐药也很显著，头孢氨苄的耐药率为34.4%，头孢唑林为40.0%，头孢曲松为16.9%。
DEC和志贺菌属被确定为腹泻的主要原因，常见细菌分离株中观察到显著的耐药模式。这些发现强调了在儿科病例中进行DEC筛查的必要性，并强调了持续进行抗菌药物耐药监测的必要性。
