中臺灣一區域醫院2007年五月至2010年十月間沙門氏菌血清型流行病學研究

Epidemiological Study of Salmonella Serogroups from May 2007 to October 2010 in a Regional Teaching Hospital in Mid-Taiwan

目的：最近的研究指出，在台灣數量最多的細菌性腸炎病患中沙門氏菌的血清型可能會發生變化。為了要確定主要沙門氏菌的血清型和抗生素抗藥性的程度與感染的發生率，於是我們收集中台灣一區域教學醫院之沙門氏菌腸炎病例做流行病學分析。方法：2007年5月至2010年10月間，回顧病歷之醫療記錄來審查年齡在15歲以下患有沙門氏菌腸炎的病毒童，收集了關於人口學年紀的分佈、臨床表現、和微生物記錄的數據血清型，分析其傳染源和抗生素抗藥性。結果：本研究一共收集了173個案例，其中年齡分佈顯示，年齡小於1歲有32例（18.50％），1至5歲有97例（56.07％），5歲以上有44例（25.43％）例。最常見的血清型為B（42.77％），其次是D（23.69％），C2（13.29％），C1（7.51％），和E（6.93％）。血清型B感染的發病率在研究期間的分析顯示，它已從2007年48％下降至2010年的36.8％，。抗生素抗藥性檢測的結果顯示，173株中47.4％對Ampicillin有抗藥性，但對於第三代頭孢菌素只有5.2％有抗藥性。結論：儘管沙門氏菌血清型B是最常見感染的血清型，在研究期間，其發病率有下降之趨勢。由於Ampicillin相對高的抗藥性比率，所以應該考慮使用第三代頭孢菌素來治療中度至重度沙門氏菌腸炎之病患。

Purposes: Recent research indicates that the Salmonella serogroup, which is responsible for the largest number of cases of bacterial enterocolitis in Taiwan, may be changing. To determine the incidence of infection with the major Salmonella serogroups and the extent of antibiotic resistance, the epidemiology of Salmonella enterocolitis patients treated at one regional teaching hospital in mid-Taiwan was analyzed. Methods: The medical records of patients under 15 years of age who had been diagnosed with Salmonella enterocolitis between May 2007 and October 2010 were reviewed. Demographic and clinical variables and the microbiological records of antibiotic resistance were collected. Results: A total of 173 isolates were analyzed in this study. Analysis of age distribution revealed that 32 patients (18.50%) were younger than 1 year, 97 (56.07%) were 1 to 5 years old, and 44 (25.43%) were over 5 years old. The most common serogroup was B (42.77%), followed by D (23.69%), C2 (13.29%), C1 (7.51%), and E (6.93%). Analysis of the incidence of serogroup B infection over the study period revealed that it had decreased from 48% in 2007 to 36.8% in 2010. The results of antibiotic resistance analyses revealed that 47.4% of the 173 strains were resistant to ampicillin but only 5.2% to third-generation cephalosporin. Conclusions: Although Salmonella serogroup B was the most responsible for infection, its prevalence decreased over the study period. Due to the relatively high rate of ampicillin resistance, third-generation cephalosporin should be considered for treating moderate to severe cases of Salmonella enterocolitis.