Yurdakök K, Sahin N, Ozmert E, Berkman E
Department of Social Pediatrics, Hacettepe University Institute of Child Health, Ankara, Turkey.
Acta Paediatr Jpn. 1997 Dec;39(6):681-4. doi: 10.1111/j.1442-200x.1997.tb03667.x.
The epidemiology and antibiotic sensitivity of Shigella species is changing worldwide. The present study surveyed the changing clinical and epidemiological characteristics and antibiotic susceptibility of Shigella gastroenteritis in Hacettepe University Ihsan Dogramaci Children's Hospital Diarrhoea Training and Treatment Unit between 1987 and 1994. Among 19,812 diarrheal admissions, 618 (3.2%) patient files with Shigella gastroenteritis were reviewed retrospectively. Shigella soneii has been the commonest isolate (64%) since 1987 followed by S. flexineri (30%), S. boydii (5%) and S. dysenteriae (1%), the latter having not been isolated since 1990. The isolate rate of S. sonnei has increased whereas the isolation rate of S. flexineri has decreased concomitantly since 1987 (r = -0.94; P < 0.001). The majority of cases (365/618, 59%) were between 1 and 5 years of age. On admission bloody diarrhea was present in 36%, seizures in 3% and mild-moderate dehydration in 11% of cases. No case had severe dehydration. Only six patients (1%) were hospitalized. No deaths were recorded. The resistance rate for trimethoprim-sulfamethoxazole has increased from 27% in 1990 to 66% in 1994 (P < 0.05) while the resistance rate for ampicillin has decreased from 81% in 1987 to 32% in 1993 (P < 0.001). Shigella flexineri was found to have higher resistance rates to ampicillin, sulbactam-ampicillin, chloramphenicol and gentamicin than S. sonnei. Changing Shigella sp. over the years may be the reason for the mild course of Shigella gastroenteritis. Further regional epidemiological studies are necessary to develop more appropriate management guidelines, especially in developing countries.
志贺氏菌属的流行病学和抗生素敏感性在全球范围内正在发生变化。本研究调查了1987年至1994年间在哈杰泰佩大学伊哈桑·多格拉马西儿童医院腹泻培训与治疗科室中，志贺氏菌性肠胃炎不断变化的临床和流行病学特征以及抗生素敏感性。在19812例腹泻住院病例中，回顾性审查了618例（3.2%）志贺氏菌性肠胃炎患者档案。自1987年以来，宋内志贺氏菌一直是最常见的分离菌株（64%），其次是福氏志贺氏菌（30%）、鲍氏志贺氏菌（5%）和痢疾志贺氏菌（1%），后者自1990年以来未再分离到。自1987年以来，宋内志贺氏菌的分离率上升，而福氏志贺氏菌的分离率相应下降（r = -0.94；P < 0.001）。大多数病例（365/618，59%）年龄在1至5岁之间。入院时，36%的病例有血性腹泻，3%有惊厥，11%有轻度至中度脱水。无病例出现重度脱水。仅6例患者（1%）住院。无死亡记录。甲氧苄啶-磺胺甲恶唑的耐药率从1990年的27%上升至1994年的66%（P < 0.05），而氨苄西林的耐药率从1987年的81%降至1993年的32%（P < 0.001）。发现福氏志贺氏菌对氨苄西林、舒巴坦-氨苄西林、氯霉素和庆大霉素的耐药率高于宋内志贺氏菌。多年来志贺氏菌属的变化可能是志贺氏菌性肠胃炎病程较轻的原因。有必要开展进一步的区域流行病学研究，以制定更合适的管理指南，尤其是在发展中国家。
