台灣中南部某區域醫院非傷寒沙門氏菌血清群分布趨勢及抗藥性分析

Distribution trend and drug resistance analysis of non-typhoidal Salmonella serogroups in a regional hospital in central and southern Taiwan

沙門氏菌為全球常見的腸胃道致病菌，在國內細菌性食物中毒案件中排名第三。沙門氏菌可分為傷寒沙門氏菌及非傷寒沙門氏菌，臨床上常見的沙門氏菌感染多為非傷寒沙門氏菌。沙門氏菌具侵襲性，在感染人類腸道後，可經由腸道侵襲進入血液中，引起敗血症。臨床上常以Kauffmann-White法進行非傷寒沙門氏菌抗血清分類，目前血清群分類至少可區分為46群，各血清群又可進一步細分不同的血清型，目前已知有2600多種血清型。然而進行血清型分析需耗費較多的時間與試劑，不符合臨床處理的急迫性，因此臨床實驗室多數以血清群進行報告。本篇研究針對近十年(2012~2021年)台灣中南部某區域醫院所分離之非傷寒沙門氏菌之血清群進行分布趨勢分析，發現非傷寒沙門氏菌自2017年起感染人次明顯上升，血清群分布趨勢也在該年度有了變化，Salmonella enterica serogroup D成為非傷寒沙門氏菌感染中最常見的血清群。此外，本篇研究針對臨床上，分離最多的非傷寒沙門氏菌：Salmonella enterica serogroup D及Salmonella enterica serogroup B，進一步分析二種血清群在不同抗生素抗藥表現之差異。結果發現二種血清群對於抗生素ampicillin、ciprofloxacin、ceftriaxone、Trimethoprim-sulfamethoxazole的抗藥比例差異甚大。臨床上，血清分群結果較抗生素藥敏試驗能提早16-18小時完成，此篇研究結果可提供臨床醫師在率先收到血清分群結果時，作為臨床醫師抗生素使用參考，盡早投入適當抗生素，避免敗血症發生。

Salmonella is a common gastrointestinal pathogen worldwide. In addition, it ranks third in domestic cases of bacterial food poisoning. Salmonella can be classified into typhoid Salmonella and non-typhoid Salmonella (NTS) strains, with clinical cases of Salmonella infection most commonly being attributed to NTS. Salmonella is invasive, after infecting the human intestine, it can invade the bloodstream, leading to sepsis. The Kauffmann-White scheme is often used for the identification of Salmonella by antisera in the clinical laboratories. Currently, there are at least 46 recognized serogroups, which can be further divided into various serotypes, with over 2600 known serotypes. Because of the cost and time, serogroup identification of NTS is more common than serotyping in clinical. This study analyzed the distribution trend of NTS serogroup isolated from a regional hospital in central and southern Taiwan in the past decade. We found that the isolates of NTS have increased significantly since 2017, especially in Salmonella enterica serogroup D. Salmonella enterica serogroup B and Salmonella enterica serogroup D were most commonly NTS from 2012 to 2021. Furthermore, this study further evaluated the differences in antibiotic resistance between these two serogroups. Serogrouping results are obtained more rapidly compared to antibiotic susceptibility testing. This is the first long-term study for analyzing drug resistance of NTS serogroup in central and southern Taiwan. By providing clinicians with serogroup data ahead of antimicrobial susceptibility testing, this research offers valuable insights for treatment decisions as early as possible to avoid the occurrence of sepsis.