Clinical Features And Etiology Analysis Of Clinically Diagnosed Patients With Acute Bacterial Dysentery

Objective:In order to investigate the epidemiological and clinical features of acute bacterial dysentery and its pathogen distribution and drug resistance,and to analyze the conformance between clinical diagnosis and etiologic diagnosis of acute bacterial dysentery.Data and Methods:The research objects are clinically diagnosed cases of adult patients with acute bacterium dysentery according to the diagnosis standard of bacterial and amebic dysentery (WS287-2008), who were received treatment in a third class hosipital of TianJin from May to October in2010and2011. In order to provide useful information for the control of bacillary dysentery, the clinical and epidemiological data of the cases has been collected and summarized. Collect the faeces of the clinical diagnosed patients with acute bacillary dysentery for bacterial culture.Pathogens were separated clearly by biochemical identification and serological identification, and were detected by K-B drug-sensitivity test.All data create database in the type of excel and will be analyzed by SPSS software.Results:In the research,780patients diagnosed clinically as acute bacterium dysente-ry were surveyed,364cases are male,416cases are female; Age composition with21-30is the most, a total of310patients (39.74%). Vocational distribution is young students of396patients (50.76%), migrant workers of192patients (24.62%), retirees of147patients (18.85%), unknown of45patients (5.77%). All780cases had diarrhea, while daily diarrhea11-20times was the most group with a total of268patients (34.36%). There were493patients(63.21%) with fever;the temperature were almost between low level and moderate degree (37.3-39℃).The typical symptoms such as purulent blood and performance in urgent hind heavy, were only14.10%and16.54%respectively,and the typical performance of the left lower quadrant abdominal tenderness also only accounted for11.92%. Pathogen detection results show that:The pathogen detection rate is23.46%.There were183strains pathogens have been detected from the780feces of clinical diagnosed bacillary dysentery cases, including93strains of Shigella(11.92%),38strains of Salmonella(4.87%),20strains of diarrheagenic Escherichia coli (2.57%),9strains of Proteus(1.15%),22strains of Citrobacter (2.82%),one Staphylococcus aureus (0.13%). Drug-sensitivity test results showed that:The drug-resistant rates of the shigella to Ampicillin, Trimethoprim-Sul-famethoxazole,Gentamicin and Chloramphenicol were over95.00%,even up to100%. To Nalidixic acid the resistance rate was98.92%, followed by Lomefloxacin(25.81%); the shigella strains were more sensitive to Norfloxacin, Ofloxacin, Levofloxacin; the sensitivity to Ciprofloxacin had a downward trend. The resistance rate to Furazolido-ne,Amikacin and Third-generation Cephalosporin were3.23%-7.53%,and no Imipen-em resistant strains were found. Moreover the multi-drug resistant strains is up to98.92%. Comparison between the three major diarrheal pathogens including Shigella, Salmonella and diarrheagenic Escherichia coli, showed that there was a certain difference of antibiotic resistance to17antibiotics.Conclusion:In this area, clinically diagnosed patients with acute bacterium dysentery were mainly young people, only about a quarter of cases had clear or suspicious unclean food history, nearly half of patients had used antibiotics by themselves. Clinical performance was light or not typical case primarily. Etiology diagnosed coincidence rate of Clinically diagnosed adult patients with acute bacterium dysentery was low, the shigella bacteria infection of pathogenic bacteria was one of the factors. S.sonnei had been the popular strains.The multiple resistance of shigella was serious.But Cephalosporin and part of Fluoroquinolones to which shigella were sensitive still could be used as the first choice for the treatment of Shigellosis.