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Article(id=1154125577633124755, tenantId=1146029695717560320, journalId=1149652044408987649, issueId=1153429493357203682, articleNumber=null, orderNo=null, doi=10.19812/j.cnki.jfsq11-5956/ts.20241017001, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1729094400000, receivedDateStr=2024-10-17, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1753094580324, onlineDateStr=2025-07-21, pubDate=1741968000000, pubDateStr=2025-03-15, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1753094580324, onlineIssueDateStr=2025-07-21, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1753094580324, creator=13701087609, updateTime=1753094580324, updator=13701087609, issue=Issue{id=1153429493357203682, tenantId=1146029695717560320, journalId=1149652044408987649, year='2025', volume='16', issue='5', pageStart='1', pageEnd='326', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1752928620900, creator=13701087609, updateTime=1758690311058, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1177595773500932351, tenantId=1146029695717560320, journalId=1149652044408987649, issueId=1153429493357203682, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1177595773500932352, tenantId=1146029695717560320, journalId=1149652044408987649, issueId=1153429493357203682, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=302, endPage=309, ext={EN=ArticleExt(id=1154125578123858338, articleId=1154125577633124755, tenantId=1146029695717560320, journalId=1149652044408987649, language=EN, title=Foodborne diseases surveillance and analysis of drug resistance of pathogenic bacteria in Jinshan District of Shanghai in 2023, columnId=1153433739154678309, journalTitle=Journal of Food Safety & Quality, columnName=Food Safety Supervision and Management, runingTitle=null, highlight=null, articleAbstract=

Objective To investigate the epidemiological characteristics and drug resistance of foodborne disease cases and pathogens in Jinshan District of Shanghai. Methods The case information of foodborne diseases in 15 sentinel medical institutions in Jinshan District was monitored in 2023, and the positive bacteria in the stool samples of patients were rechecked, identified, and tested for drug sensitivity. Results In 2023, a total of 408 cases of foodborne diseases were reported in Jinshan District, the male to female ratio was 5:4, most of them were 18-34 years old, the occupation was mainly workers, migrant workers and farmers, and the incidence was high from May to September. Except for multiple and mixed foods, vegetables and fruits accounted for a relatively high proportion in suspicious exposed foods. The detection rate of pathogenic bacteria was 21.46% (47/219), diarrheagenic Escherichia coli was the main pathogen, and norovirus was 18.72% (41/219). The results of drug sensitivity showed that the proportion of multi-drug resistant strains in Salmonella was 83.33% (10/12). Conclusion In the 2023 foodborne disease surveillance in Jinshan District, norovirus and diarrheagenic Escherichia coli are the main pathogenic agents. Among the pathogenic bacteria, both Salmonella and diarrheagenic Escherichia coli shows varying degrees of drug resistance. It is necessary to continue strengthening the monitoring of foodborne diseases. Meanwhile, relevant departments shall enhance public awareness of antibiotic resistance, and strengthen the management, rational use and sensitivity testing of various antibiotics.

, correspAuthors=Fu-Bin QIU, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, authorCompany=null, fund=null, authors=null, authorsList=Chen-Chen LI, Chong-Xiu SUN, Chun-Fu LIU, Zhe-Yan WU, Jian-Ming ZHU, Fu-Bin QIU), CN=ArticleExt(id=1154125585317089818, articleId=1154125577633124755, tenantId=1146029695717560320, journalId=1149652044408987649, language=CN, title=2023年上海市金山区食源性疾病监测及致病菌耐药性分析, columnId=1153433739318256173, journalTitle=食品安全质量检测学报, columnName=食品安全监管, runingTitle=null, highlight=null, articleAbstract=

目的 探究上海市金山区食源性疾病病例及致病病原体流行病学特征和耐药情况。方法 2023年监测金山区15家哨点医疗机构食源性疾病病例信息并对患者粪便样本中的阳性菌株进行复核、分型鉴定和药敏实验。结果 2023年金山区共报告食源性疾病病例408例, 男女性别比5:4, 以18~34岁者最多, 职业以工人、民工、农民为主, 以5—9月高发, 可疑暴露食品除多种及混合食品外, 以蔬菜水果类占比较高。致病菌检出率为21.46% (47/219), 以致泻大肠埃希氏菌为主, 诺如病毒为18.72% (41/219)。药敏结果中沙门氏菌多重耐药菌株占比达83.33% (10/12)。结论 2023年金山区食源性疾病监测中诺如病毒和致泻大肠埃希菌为主要致病病原体, 致病菌中沙门氏菌和致泻大肠埃希菌均有不同程度耐药, 需继续加强食源性疾病监测, 同时相关部门应加强抗生素耐药科普和各类抗生素管理、合理使用和敏感检测。

, correspAuthors=邱服斌, authorNote=null, correspAuthorsNote=
* 邱服斌(1968—), 男, 博士, 教授, 主要研究方向为食品营养与慢性病预防。E-mail:
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李晨晨(1991—), 女, 硕士, 主管医师, 主要研究方向为食品安全风险监测与评估研究。E-mail:

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李晨晨(1991—), 女, 硕士, 主管医师, 主要研究方向为食品安全风险监测与评估研究。E-mail:

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李晨晨(1991—), 女, 硕士, 主管医师, 主要研究方向为食品安全风险监测与评估研究。E-mail:

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Research progress on epidemic trend and antimicrobial resistance research of foodborne Salmonella[J]. Journal of Food Safety & Quality, 2021, 12(9): 3542-3549., articleTitle=Research progress on epidemic trend and antimicrobial resistance research of foodborne Salmonella, refAbstract=null)], funds=[Fund(id=1177619372194541587, tenantId=1146029695717560320, journalId=1149652044408987649, articleId=1154125577633124755, awardId=JSJK-KTMS-2021-06, language=CN, fundingSource=上海市金山区卫生健康专项面上科研项目(JSJK-KTMS-2021-06), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1177619368449029052, tenantId=1146029695717560320, journalId=1149652044408987649, articleId=1154125577633124755, xref=null, ext=[AuthorCompanyExt(id=1177619368453223357, tenantId=1146029695717560320, journalId=1149652044408987649, articleId=1154125577633124755, companyId=1177619368449029052, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1. Jinshan District Center for Disease Control and Prevention, Shanghai 201599, China), AuthorCompanyExt(id=1177619368457417662, tenantId=1146029695717560320, journalId=1149652044408987649, articleId=1154125577633124755, companyId=1177619368449029052, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.上海市金山区疾病预防控制中心, 上海 201599)]), AuthorCompany(id=1177619368520332223, tenantId=1146029695717560320, journalId=1149652044408987649, articleId=1154125577633124755, xref=null, ext=[AuthorCompanyExt(id=1177619368524526528, tenantId=1146029695717560320, journalId=1149652044408987649, articleId=1154125577633124755, companyId=1177619368520332223, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2. School of Public Health, Shanxi Medical University, Taiyuan 030001, China), AuthorCompanyExt(id=1177619368528720833, tenantId=1146029695717560320, journalId=1149652044408987649, articleId=1154125577633124755, companyId=1177619368520332223, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.山西医科大学公共卫生学院, 太原 030001)])], figs=[ArticleFig(id=1177619371053691895, tenantId=1146029695717560320, journalId=1149652044408987649, articleId=1154125577633124755, language=EN, label=Fig.1, caption=Distribution of visiting time of foodborne disease cases and sampling in different months in Jinshan District, Shanghai, in 2023, figureFileSmall=d72wIkFS/kw0Iy3TlnHqFQ==, figureFileBig=92I5v/l9iScwQEXnFuoNGA==, tableContent=null), ArticleFig(id=1177619371108217849, tenantId=1146029695717560320, journalId=1149652044408987649, articleId=1154125577633124755, language=CN, label=图1, caption=2023年上海市金山区食源性疾病病例就诊及采样时间分布, figureFileSmall=d72wIkFS/kw0Iy3TlnHqFQ==, figureFileBig=92I5v/l9iScwQEXnFuoNGA==, tableContent=null), ArticleFig(id=1177619371166938109, tenantId=1146029695717560320, journalId=1149652044408987649, articleId=1154125577633124755, language=EN, label=Fig.2, caption=Distribution of different pathogenic detection rate of foodborne diseases in different months in Jinshan District, Shanghai, in 2023, figureFileSmall=+ZpPFOt4M/IbyGBNE12SxA==, figureFileBig=SyIZPzDokdDkxLStTRhRCg==, tableContent=null), ArticleFig(id=1177619371234046975, tenantId=1146029695717560320, journalId=1149652044408987649, articleId=1154125577633124755, language=CN, label=图2, caption=2023年上海市金山区食源性疾病监测不同月份不同病原体检出情况, figureFileSmall=+ZpPFOt4M/IbyGBNE12SxA==, figureFileBig=SyIZPzDokdDkxLStTRhRCg==, tableContent=null), ArticleFig(id=1177619371309543424, tenantId=1146029695717560320, journalId=1149652044408987649, articleId=1154125577633124755, language=EN, label=Table 1, caption=

Distribution of food-borne disease cases in Jinshan District, Shanghai, in 2023

, figureFileSmall=null, figureFileBig=null, tableContent=
组别 总病例数/例 采样病例数/例 阳性病例数/例 阳性构成比/% 总检出率/% χ2 P
性别
男 227 116 42 51.22 36.21 0.161 0.688
女 181 103 40 48.78 38.83
年龄/岁
0~1 8 8 3 3.66 37.50 6.024 0.537
2~5 18 18 10 12.20 55.56
6~17 26 17 5 6.10 29.41
18~34 125 77 23 28.05 29.87
35~44 55 33 13 15.85 39.39
45~54 46 19 7 8.54 36.84
55~64 55 28 13 15.85 46.43
65~ 75 19 8 9.76 42.11
职业
干部职员 81 77 29 35.37 37.66 9.558 0.145
离退人员 72 40 20 24.39 50.00
散居儿童 31 31 13 15.85 41.94
学生 27 16 6 7.32 37.50
工人/民工/农民 109 12 2 2.44 16.67
家务及待业 27 10 5 6.10 50.00
其他 61 33 7 8.54 21.21
食品分类
多种及混合食品 122 81 35 42.68 43.21 5.718 0.335
水产动物及其制品 68 45 13 15.85 28.89
肉与肉制品 54 28 13 15.85 46.43
蔬菜水果类 79 32 12 14.63 37.50
粮食类及其制品 36 14 5 6.10 35.71
其他类食品 49 19 4 4.88 21.05
进食场所
家庭 347 195 74 90.24 37.95 0.032a 0.857
餐饮服务店 48 20 8 9.76 40.00
学校 6 3 0 0.00 0.00
集体食堂 4 1 0 0.00 0.00
其他 3 0 0 0.00 -
), ArticleFig(id=1177619371464732676, tenantId=1146029695717560320, journalId=1149652044408987649, articleId=1154125577633124755, language=CN, label=表1, caption=

2023年上海市金山区食源性疾病病例分布情况

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组别 总病例数/例 采样病例数/例 阳性病例数/例 阳性构成比/% 总检出率/% χ2 P
性别
男 227 116 42 51.22 36.21 0.161 0.688
女 181 103 40 48.78 38.83
年龄/岁
0~1 8 8 3 3.66 37.50 6.024 0.537
2~5 18 18 10 12.20 55.56
6~17 26 17 5 6.10 29.41
18~34 125 77 23 28.05 29.87
35~44 55 33 13 15.85 39.39
45~54 46 19 7 8.54 36.84
55~64 55 28 13 15.85 46.43
65~ 75 19 8 9.76 42.11
职业
干部职员 81 77 29 35.37 37.66 9.558 0.145
离退人员 72 40 20 24.39 50.00
散居儿童 31 31 13 15.85 41.94
学生 27 16 6 7.32 37.50
工人/民工/农民 109 12 2 2.44 16.67
家务及待业 27 10 5 6.10 50.00
其他 61 33 7 8.54 21.21
食品分类
多种及混合食品 122 81 35 42.68 43.21 5.718 0.335
水产动物及其制品 68 45 13 15.85 28.89
肉与肉制品 54 28 13 15.85 46.43
蔬菜水果类 79 32 12 14.63 37.50
粮食类及其制品 36 14 5 6.10 35.71
其他类食品 49 19 4 4.88 21.05
进食场所
家庭 347 195 74 90.24 37.95 0.032a 0.857
餐饮服务店 48 20 8 9.76 40.00
学校 6 3 0 0.00 0.00
集体食堂 4 1 0 0.00 0.00
其他 3 0 0 0.00 -
), ArticleFig(id=1177619371590561798, tenantId=1146029695717560320, journalId=1149652044408987649, articleId=1154125577633124755, language=EN, label=Table 2, caption=

Distribution of food-borne disease pathogenic agents in Jinshan District, Shanghai, in 2023

, figureFileSmall=null, figureFileBig=null, tableContent=
组别 采样病例数/例 检出率/% χ2 P
致泻大肠埃希氏菌 沙门氏菌 副溶血性弧菌
性别 4.847a* 0.183
男 116 11.21c 6.90c,d 0.86d 10.578b 0.005
女 103 14.56c 3.88d 5.83c,d 8.965b 0.011
年龄/岁 9.307a* 0.313
0~5 26 19.23 15.38 0.00 5.916b* 0.068
6~17 17 17.65 0.00 5.88 3.158b* 0.306
18~64 157 11.46c 3.82d 3.18d 11.538b 0.003
≥65 19 10.53 10.53 5.26 0.624b* 1.000
进食场所 3.977a* 0.101
家庭 195 13.85 5.64 2.56 19.478b 0.000
餐饮服务店 20 5.00 5.00 10.00 0.703b* 1.000
), ArticleFig(id=1177619371708002312, tenantId=1146029695717560320, journalId=1149652044408987649, articleId=1154125577633124755, language=CN, label=表2, caption=

上海市金山区食源性疾病不同致病菌检出率及构成分布比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别 采样病例数/例 检出率/% χ2 P
致泻大肠埃希氏菌 沙门氏菌 副溶血性弧菌
性别 4.847a* 0.183
男 116 11.21c 6.90c,d 0.86d 10.578b 0.005
女 103 14.56c 3.88d 5.83c,d 8.965b 0.011
年龄/岁 9.307a* 0.313
0~5 26 19.23 15.38 0.00 5.916b* 0.068
6~17 17 17.65 0.00 5.88 3.158b* 0.306
18~64 157 11.46c 3.82d 3.18d 11.538b 0.003
≥65 19 10.53 10.53 5.26 0.624b* 1.000
进食场所 3.977a* 0.101
家庭 195 13.85 5.64 2.56 19.478b 0.000
餐饮服务店 20 5.00 5.00 10.00 0.703b* 1.000
), ArticleFig(id=1177619371804471308, tenantId=1146029695717560320, journalId=1149652044408987649, articleId=1154125577633124755, language=EN, label=Table 3, caption=

Resistance rates of pathogenic bacteria to 29 kinds of antibiotics monitored for foodborne diseases in Jinshan District in 2023

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类别 抗生素 致泻大肠埃希氏菌(28株) 沙门氏菌(12株) 副溶血性弧菌(7株)
耐药数/株 耐药率/% 耐药数/株 耐药率/% 耐药数/株 耐药率/%
叶酸途径抑制剂 复方磺胺 11 39.29 6 50.00 0 0.00
头孢类 头孢唑林 9 32.14 5 41.67 7 100.00
头孢呋辛 3 10.71 2 16.67 0 0.00
头孢噻呋 3 10.71 2 16.67 0 0.00
头孢噻肟 2 7.14 2 16.67 0 0.00
头孢西丁 2 7.14 0 0.00 0 0.00
头孢他啶 2 7.14 1 8.33 0 0.00
头孢吡肟 2 7.14 2 16.67 1 14.29
碳氢霉烯类 亚胺培南 0 0.00 0 0.00 0 0.00
厄他培南 0 0.00 0 0.00 0 0.00
美罗培南 0 0.00 0 0.00 0 0.00
四环素类 四环素 15 53.57 7 58.33 0 0.00
替加环素 0 0.00 0 0.00 0 0.00
乳菌肽脂肽类 多粘菌素E 0 0.00 0 0.00 7 100.00
多粘菌素B 0 0.00 2 16.67 7 100.00
青霉素类 氨苄西林 16 57.14 10 83.33 0 0.00
喹诺酮类和氟喹诺酮类 萘啶酸 11 39.29 - - 0 0.00
环丙沙星 2 7.14 1 8.33 0 0.00
大环内酯类 阿奇霉素 5 17.86 0 0.00 0 0.00
苯丙醇类 氯霉素 3 10.71 6 50.00 0 0.00
氟苯尼考 3 10.71 6 50.00 0 0.00
氨基糖苷类 链霉素 7 25.00 12 100.00 0 0.00
阿米卡星 2 7.14 2 16.67 0 0.00
庆大霉素 1 3.57 2 16.67 0 0.00
β-内酰胺/β-内酰胺抑制剂复合物 氨苄西林/舒巴坦 8 28.57 7 58.33 0 0.00
阿莫西林/克拉维酸 2 7.14 2 16.67 0 0.00
头孢噻肟/克拉维酸 2 7.14 - - - -
头孢他啶/克拉维酸 2 7.14 - - - -
头孢他啶/阿维巴坦 0 0.00 0 0.00 0 0.00
), ArticleFig(id=1177619371892551694, tenantId=1146029695717560320, journalId=1149652044408987649, articleId=1154125577633124755, language=CN, label=表3, caption=

2023年金山区食源性疾病监测致病菌对29种抗生素的耐药率

, figureFileSmall=null, figureFileBig=null, tableContent=
类别 抗生素 致泻大肠埃希氏菌(28株) 沙门氏菌(12株) 副溶血性弧菌(7株)
耐药数/株 耐药率/% 耐药数/株 耐药率/% 耐药数/株 耐药率/%
叶酸途径抑制剂 复方磺胺 11 39.29 6 50.00 0 0.00
头孢类 头孢唑林 9 32.14 5 41.67 7 100.00
头孢呋辛 3 10.71 2 16.67 0 0.00
头孢噻呋 3 10.71 2 16.67 0 0.00
头孢噻肟 2 7.14 2 16.67 0 0.00
头孢西丁 2 7.14 0 0.00 0 0.00
头孢他啶 2 7.14 1 8.33 0 0.00
头孢吡肟 2 7.14 2 16.67 1 14.29
碳氢霉烯类 亚胺培南 0 0.00 0 0.00 0 0.00
厄他培南 0 0.00 0 0.00 0 0.00
美罗培南 0 0.00 0 0.00 0 0.00
四环素类 四环素 15 53.57 7 58.33 0 0.00
替加环素 0 0.00 0 0.00 0 0.00
乳菌肽脂肽类 多粘菌素E 0 0.00 0 0.00 7 100.00
多粘菌素B 0 0.00 2 16.67 7 100.00
青霉素类 氨苄西林 16 57.14 10 83.33 0 0.00
喹诺酮类和氟喹诺酮类 萘啶酸 11 39.29 - - 0 0.00
环丙沙星 2 7.14 1 8.33 0 0.00
大环内酯类 阿奇霉素 5 17.86 0 0.00 0 0.00
苯丙醇类 氯霉素 3 10.71 6 50.00 0 0.00
氟苯尼考 3 10.71 6 50.00 0 0.00
氨基糖苷类 链霉素 7 25.00 12 100.00 0 0.00
阿米卡星 2 7.14 2 16.67 0 0.00
庆大霉素 1 3.57 2 16.67 0 0.00
β-内酰胺/β-内酰胺抑制剂复合物 氨苄西林/舒巴坦 8 28.57 7 58.33 0 0.00
阿莫西林/克拉维酸 2 7.14 2 16.67 0 0.00
头孢噻肟/克拉维酸 2 7.14 - - - -
头孢他啶/克拉维酸 2 7.14 - - - -
头孢他啶/阿维巴坦 0 0.00 0 0.00 0 0.00
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2023年上海市金山区食源性疾病监测及致病菌耐药性分析
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李晨晨 1 , 孙重秀 1 , 刘春甫 1 , 吴哲妍 1 , 朱建明 1 , 邱服斌 2, *
食品安全质量检测学报 | 食品安全监管 2025,16(5): 302-309
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食品安全质量检测学报 | 食品安全监管 2025, 16(5): 302-309
2023年上海市金山区食源性疾病监测及致病菌耐药性分析
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李晨晨1 , 孙重秀1, 刘春甫1, 吴哲妍1, 朱建明1, 邱服斌2, *
作者信息
  • 1.上海市金山区疾病预防控制中心, 上海 201599
  • 2.山西医科大学公共卫生学院, 太原 030001

    • 李晨晨(1991—), 女, 硕士, 主管医师, 主要研究方向为食品安全风险监测与评估研究。E-mail:

通讯作者:

* 邱服斌(1968—), 男, 博士, 教授, 主要研究方向为食品营养与慢性病预防。E-mail:
Foodborne diseases surveillance and analysis of drug resistance of pathogenic bacteria in Jinshan District of Shanghai in 2023
Chen-Chen LI1 , Chong-Xiu SUN1, Chun-Fu LIU1, Zhe-Yan WU1, Jian-Ming ZHU1, Fu-Bin QIU2, *
Affiliations
  • 1. Jinshan District Center for Disease Control and Prevention, Shanghai 201599, China
  • 2. School of Public Health, Shanxi Medical University, Taiyuan 030001, China
出版时间: 2025-03-15 doi: 10.19812/j.cnki.jfsq11-5956/ts.20241017001
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摘要
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目的 探究上海市金山区食源性疾病病例及致病病原体流行病学特征和耐药情况。方法 2023年监测金山区15家哨点医疗机构食源性疾病病例信息并对患者粪便样本中的阳性菌株进行复核、分型鉴定和药敏实验。结果 2023年金山区共报告食源性疾病病例408例, 男女性别比5:4, 以18~34岁者最多, 职业以工人、民工、农民为主, 以5—9月高发, 可疑暴露食品除多种及混合食品外, 以蔬菜水果类占比较高。致病菌检出率为21.46% (47/219), 以致泻大肠埃希氏菌为主, 诺如病毒为18.72% (41/219)。药敏结果中沙门氏菌多重耐药菌株占比达83.33% (10/12)。结论 2023年金山区食源性疾病监测中诺如病毒和致泻大肠埃希菌为主要致病病原体, 致病菌中沙门氏菌和致泻大肠埃希菌均有不同程度耐药, 需继续加强食源性疾病监测, 同时相关部门应加强抗生素耐药科普和各类抗生素管理、合理使用和敏感检测。

食源性疾病  /  监测  /  病原体  /  药敏实验  /  抗生素  /  耐药性

Objective To investigate the epidemiological characteristics and drug resistance of foodborne disease cases and pathogens in Jinshan District of Shanghai. Methods The case information of foodborne diseases in 15 sentinel medical institutions in Jinshan District was monitored in 2023, and the positive bacteria in the stool samples of patients were rechecked, identified, and tested for drug sensitivity. Results In 2023, a total of 408 cases of foodborne diseases were reported in Jinshan District, the male to female ratio was 5:4, most of them were 18-34 years old, the occupation was mainly workers, migrant workers and farmers, and the incidence was high from May to September. Except for multiple and mixed foods, vegetables and fruits accounted for a relatively high proportion in suspicious exposed foods. The detection rate of pathogenic bacteria was 21.46% (47/219), diarrheagenic Escherichia coli was the main pathogen, and norovirus was 18.72% (41/219). The results of drug sensitivity showed that the proportion of multi-drug resistant strains in Salmonella was 83.33% (10/12). Conclusion In the 2023 foodborne disease surveillance in Jinshan District, norovirus and diarrheagenic Escherichia coli are the main pathogenic agents. Among the pathogenic bacteria, both Salmonella and diarrheagenic Escherichia coli shows varying degrees of drug resistance. It is necessary to continue strengthening the monitoring of foodborne diseases. Meanwhile, relevant departments shall enhance public awareness of antibiotic resistance, and strengthen the management, rational use and sensitivity testing of various antibiotics.

foodborne diseases  /  surveillance  /  pathogens  /  drug susceptibility test  /  antibiotics  /  drug resistance
李晨晨, 孙重秀, 刘春甫, 吴哲妍, 朱建明, 邱服斌. 2023年上海市金山区食源性疾病监测及致病菌耐药性分析. 食品安全质量检测学报, 2025 , 16 (5) : 302 -309 . DOI: 10.19812/j.cnki.jfsq11-5956/ts.20241017001
Chen-Chen LI, Chong-Xiu SUN, Chun-Fu LIU, Zhe-Yan WU, Jian-Ming ZHU, Fu-Bin QIU. Foodborne diseases surveillance and analysis of drug resistance of pathogenic bacteria in Jinshan District of Shanghai in 2023[J]. Journal of Food Safety & Quality, 2025 , 16 (5) : 302 -309 . DOI: 10.19812/j.cnki.jfsq11-5956/ts.20241017001
正文
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0 引言
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据世界卫生组织(World Health Organization, WHO)估计, 全球每年有6亿人(约1/10全球人口)因食用受污染的食品而患病, 并有42万人死亡[1]。在美国, 每年有940万人因食源性病原体的感染而患病, 约1350人死亡[2]。我国报告平均每6.5人中, 就有1人因摄入污染了致病菌的食物而患病[3]。食源性疾病已成为全球公认重大公共卫生问题之一[4-5]。它所带来的疾病负担, 尤其对中低等收入国家经济影响最大, 每年因食用不安全食品造成的生产力损失、贸易相关损失和医疗费用估计高达1100亿美元[4]。2022年WHO公布《2022—2030年全球食品安全战略》具体目标, 即减少食源性疾病的负担, 使大多数5岁以下儿童和其他弱势群体的食源性腹泻发病率降低40%[6]。在我国, 引起发病人数最多的是微生物性因素, 与多个国家(地区)相同[7]。为评估和预防食源性肠道感染的进展, 世界多个国家建立各自相应的食源性疾病监测体系, 主要通过各监测点对由食物中病原体引起的感染性/中毒性疾病进行监测。据文献报道, 美国每年主动监测的病原体主要有8种, 分别为弯曲菌、沙门氏菌、志贺氏菌、单增李斯特菌、产志贺毒素大肠杆菌、耶尔森氏菌、弧菌和环孢菌[2]。我国食源性疾病监测体系, 目前主动监测5种病原体, 包括致泻大肠埃希氏菌、沙门氏菌、副溶血性弧菌、志贺氏菌和诺如病毒, 部分经济发达省市增加弯曲菌监测[8]。
在我国, 大多数微生物性食源性疾病被归类为感染性腹泻, 属于法定丙类传染病[9], 但在风险因素的暴露、耐药性等方面没有得到充分的记录, 特别是在以急性肠胃炎为特征的病例中。本研究基于食源性疾病监测体系, 对2023年上海市金山区各监测点医院上报的食源性疾病病例监测数据、实验室确诊病例病原体检测复核结果及致病菌药敏实验结果进行整理分析, 旨在了解上海市金山区食源性疾病病原体流行病学特征及人群对致病菌耐药状况, 为金山区食源性疾病的监管和防控工作提供科学依据。
1 材料与方法
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1.1 样品采集
收集2023年上海市金山区内开展食源性疾病监测的15家医疗机构上报的病例信息408例, 包括主动监测哨点医院病例信息219例。病例信息包括就诊病例基本信息、可疑食物暴露史及临床主要症状等信息。2023年4月始主动监测哨点医院采集病例粪便进行病原体检测, 检测项目包括沙门氏菌、致泻大肠埃希菌、志贺氏菌、副溶血性弧菌和诺如病毒, 门诊医生采集病例粪便样本于4 ℃冷藏保存, 24 h内由医院实验室进行检测, 待复核样本和阳性菌株暂于-20 ℃保存, 每月第一周、第三周将菌株和阳性样本送至金山区疾病预防控制中心进行复核及分型鉴定。主动监测的病例为由食品或怀疑由食品引起的, 以腹泻症状为主诉的感染病例。腹泻是指24 h内排便≥3次且粪便性状异常, 如稀便、水样便、黏液便或脓血便等。
1.2 试剂与仪器
肠道增菌液、肉汤培养基、碱性蛋白胨、营养琼脂平板、麦康凯琼脂平板、伊红美兰琼脂平板、弧菌显色平板、沙门氏菌显色平板(上海科玛嘉微生物技术有限公司); 5种致泻大肠埃希氏菌核酸检测试剂盒和诺如病毒GⅠ/GⅡ双重荧光聚合酶链式反应(polymerase chain reaction, PCR)检测试剂盒(江苏硕世生物科技股份有限公司); 革兰阴性需氧菌药敏检测板[复星诊断科技(上海)有限公司]; 沙门菌属诊断血清、志贺菌属血清(宁波天润生物药业有限公司)。所用试剂均经质控验收, 并在有效期内使用。
VITEK® 2全自动微生物鉴别及药敏分析系统(法国生物梅里埃公司); Autof ms 2000基质辅助激光解析电离-飞行时间质谱仪(郑州安图生物工程公司); 实时荧光PCR仪(上海宏石医疗科技有限公司)。
1.3 实验方法
实验室人员按照《2023年国家食源性疾病监测工作手册》中的实验室检验标准操作程序对收到的样本开展致泻大肠埃希氏菌、沙门氏菌、志贺氏菌和副溶血性弧菌复核鉴定[8]。沙门氏菌完成血清型鉴定, 致泻大肠埃希氏菌通过PCR试验确认致泻大肠埃希氏菌类别, 同时对粪便样本进行诺如病毒核酸检测。采用微量肉汤稀释法对检出的所有食源性致病菌开展11大类29种抗生素的药敏实验, 测定致病菌的最低抑菌浓度(minimal inhibitory concentration, MIC), 结果判断根据上述工作手册推荐的临床实验室标准化协会(Clinical and Laboratory Standards Institute, CLSI)发布的CLSI M100 33th Edition、CLSI M45-A3、CLSI VET01-A4标准进行[8]。其中, 头孢噻肟/克拉维酸及头孢他啶/克拉维酸用于检测是否为产超广谱β-内酰胺酶大肠埃希氏菌(Escherichia coli producing β-lactamase, ESBLs)[10]。对任意3类及以上抗生素耐药的菌株为多重耐药(multidrug resistance, MDR)菌株。
1.4 数据处理
采用Excel 2013整理数据, SPSS 19.0对数据进行统计学分析。定性资料使用频数、率或构成比描述, 检出率=阳性病原体的样本数/该病原体检测总样本数×100%, 菌株耐药率=发生耐药的菌株数/开展该项药敏实验的菌株总数× 100%; 组间比较使用卡方检验和Fisher精确概率法, 两两比较采用Bonferroni法, 检验水准α=0.05。
2 结果与分析
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2.1 时间分布
2023年上海市金山区15家医疗机构共监测食源性疾病病例408例, 无死亡病例。除1月外, 其余月份均有食源性疾病监测病例报告; 4月起病例数逐渐增多, 8月达到全年最高峰, 占全年病例数的31.13% (127/408); 病例以5—9月较为集中, 占总病例数的84.80% (346/408), 见图1。
2.2 人群分布
2.2.1 全部报告病例
共报告病例408例, 男性227例, 女性181例, 男女比例为5:4。年龄最小的181 d, 最大的90岁。各年龄组中, 病例报告人数最多的为18~34岁, 占比30.64% (125/408); 其次为65岁及以上, 占比18.38% (75/408)。职业分布中, 工人/民工/农民和干部职员占比位居前2位, 分别为26.72% (109/408)和19.85% (81/408), 见表1。
2.2.2 主动监测病例
共采样219例, 男性116例, 女性103例, 18~34岁、35~44岁占比较高, 分别为35.16% (77/219)和15.07% (33/219)。职业以干部职员和离退人员占比较高, 分别为35.16% (77/219)和18.26% (40/219), 见表1。
2.2.3 阳性病例
检出阳性病例82例, 其中女性总检出率(38.83%, 40/103)略高于男性(36.21%, 42/116)。总检出率以2~5岁年龄组最高, 为55.56% (10/18)。职业分布总检出率以离退人员和家务及待业人员最高, 均为50.00%, 见表1。但阳性病例的分布情况在不同性别、年龄、职业、食品分类及进食场所的差异均无统计学意义(P<0.05)。
2.3 可疑食品及场所暴露史
在全部病例和主动监测病例中自诉可疑食品均以多种及混合食品占比最高, 主动监测中有肉与肉制品类食物暴露史的病例, 其病原体总检出率最高(46.43%, 13/28)。进食场所分布病原体总检出率以餐饮服务店最高(40.00%, 8/20), 病原体阳性占比以家庭报告最高(90.24%, 74/82), 见表1。
2.4 病原体流行病学
2.4.1 总体情况
本次检测中, 共检出阳性病例82例, 总检出率为37.44% (82/219)。其中5例同时检出致泻大肠埃希氏菌和诺如病毒, 占比6.10% (5/82); 1例同时检出副溶血性弧菌和诺如病毒, 占比1.22% (1/82); 阳性样本共88份。除志贺氏菌未检出外, 其余病原体(沙门氏菌、致泻大肠埃希氏菌、副溶血性弧菌和诺如病毒)均有检出。其中, 诺如病毒检出率为18.72% (41/219), 致病菌检出率为21.46% (47/219), 具体结果如下: 致泻大肠埃希氏菌为12.79% (28/219), 沙门氏菌为5.48% (12/219), 副溶血性弧菌为3.20% (7/219)。4种病原体检出率差异具有统计学意义(χ2=36.483, P<0.05), 但致泻大肠埃希氏菌检出率与诺如病毒的检出率差异无统计学意义, 与沙门氏菌和副溶血性弧菌的差异均有统计学意义。
2.4.2 病原体时间分布
副溶血性弧菌、致泻大肠埃希氏菌在6—10月均有检出且呈现相同趋势, 沙门氏菌仅在8月和9月有检出, 诺如病毒在4—11月均有检出且在11月检出率较高, 但差异不具有统计学意义。不同病原体间检出率仅在8月份差异有统计学意义(χ2=8.196, P<0.05), 且诺如病毒检出率(15.05%)高于副溶血性弧菌(3.23%)。不同月份间病原体总检出率差异不具有统计学意义(χ2=7.479, P>0.05)。见图2。
2.4.3 病原体在人群、食品分类和进食场所的分布
致病菌检出率以2~5岁年龄组最高, 为44.44% (8/18); 职业以家务及待业人员最高(40.00%, 4/10), 其次是散居儿童(29.03%, 9/31); 可疑暴露食品以蔬菜水果类最高(28.13%, 9/32), 其次为多种及混合食品(27.16%, 22/81)、肉与肉制品(25.00%, 7/28); 暴露场所以家庭最高(22.05%, 43/195)。诺如病毒检出率以0~1岁(25.00%, 2/8)和55~64岁(25.00%, 7/28)年龄组最高; 职业以干部职员最高(25.97%, 20/77), 其次是离退人员(25.00%, 10/40); 可疑暴露食品以粮食类及其制品最高(28.57%, 4/14), 其次为肉与肉制品(21.43%, 6/28)、多种及混合食品(20.99%, 17/81); 暴露场所以餐饮服务店最高(20.00%, 4/20)。但致病菌检出率分别在不同性别、年龄、职业、暴露食品及进食场所检出率差异均无统计学意义, 诺如病毒亦是如此。
2.4.4 不同致病菌的检出率及构成分布情况
不同性别病例中3种致病菌的检出率差异均有统计学意义, 且男性致泻大肠埃希氏菌检出率高于副溶血性弧菌(χ2=10.946, P<0.05), 女性致泻大肠埃希氏菌检出率高于沙门氏菌(χ2=7.015, P<0.05), 但不同性别中3种致病菌的构成分布差异不具有统计学意义(χ2=4.847, P>0.05)。从致病菌种类来看, 每种致病菌检出率在各年龄组上差异均不具有统计学意义。对年龄合并后分析, 各年龄组致泻大肠埃希氏菌的检出率均为最高, 但仅在18~64岁年龄组中3种致病菌检出率差异有统计学意义(χ2=11.538, P<0.05)。进食场所家庭中3种致病菌的检出率差异有统计学意义(χ2=19.478, P<0.05), 以致泻大肠埃希氏菌的检出率最高(13.85%, 27/195)。以上结果见表2。致泻大肠埃希氏菌检出率在蔬菜水果类中较高(15.63%, 5/32), 其次是多种及混合食品(14.81%, 12/81), 但二者差异无统计学意义(χ2=0.012, P>0.05), 构成比以多种及混合食品较高(42.86%, 12/28)。
2.4.5 病原体分型及致病菌药敏结果
2023年金山区食源性疾病监测致病菌对29种抗生素的耐药率如表3, 食源性疾病监测病原体分型鉴定结果诺如病毒以GⅡ型为主, 占比75.61% (31/41), GⅠ型占比14.63% (6/41), GⅠ型、GⅡ型混合感染占比9.76% (4/41); 致病菌共计47株, 其中致泻大肠埃希氏菌28株、沙门氏菌12株及副溶血性弧菌7株。致泻大肠埃希氏菌血清型以粘附性大肠埃希氏菌属和产肠毒素大肠埃希氏菌属为主, 分别占比39.29% (11/28)和35.71% (10/28); 致病性大肠埃希氏菌属占比21.43% (6/28), 出血性大肠埃希氏菌属占3.57% (1/28)。沙门氏菌优势血清型为鼠伤寒沙门氏菌, 占比58.33% (7/12)。
47株致病菌均为革兰氏阴性菌株, 开展29种抗生素的耐药性检测。结果发现, 致泻大肠埃希氏菌分别对氨苄西林和四环素耐药率较高(57.14%和53.57%); 沙门氏菌对链霉素、氨苄西林、四环素和氨苄西林-舒巴坦耐药率较高(100.00%、83.33%、58.33%和58.33%); 副溶血性弧菌对头孢唑林、多粘菌素B和多粘菌素E耐药率均为100.00%。
28株致泻大肠埃希氏菌总体耐药率达到78.57% (22/28), 即至少对1种实验用的抗生素发生耐药, 对3类及以上抗生素发生耐药的(即多重耐药)菌株占比达60.71% (17/28), 对7种及以上抗生素发生耐药的菌株占比近25.00% (7/28), 其中2株为ESBLs; 12株沙门氏菌总体耐药率达到100%, 多重耐药菌株占比达83.33% (10/12), 对7种及以上抗生素发生耐药的菌株占比近58.33% (7/12)。
3 结论与讨论
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本研究的最终结果显示, 2023年上海市金山区食源性疾病报告病例以5月至9月份较为集中, 8月达全年高峰, 与区内往年及国内多地省市监测结果较一致[11-13]。冬春季节报告病例较低, 病原体以诺如病毒为主, 致病菌检出率低, 这主要与气温环境变化、病原体生物活跃度以及居民饮食习惯的改变有关。本研究中诺如病毒的检出率相对较高, 这与国内外研究相一致[9,14], 需要注意的是这其中仅有一部分诺如病毒病例可归因于食源性传播。
食源性疾病报告病例以18~34岁和65岁及以上人群最多, 职业依次以工人/民工/农民和干部职员较多, 与上海市其他区以干部职员和离退人员为主存在差异[15]。上述情况可能与前者人群暴露机会多、就餐环境较差、食物存放及加工不当等有关, 后者人群外出就餐频繁和就餐形式多样所致的感染机会增多有关。在所有阳性病例中, 多种及混合食品、肉与肉制品和水产动物及其制品是主要的可疑暴露食品来源, 与常见致病菌污染的主要食品一致[12]。进食场所以家庭为主, 与上海、广州等地区监测结果相似[16-18], 与家庭食物加工、保存方式及进食习惯密切相关, 该结果也提示日常食源性疾病防制和宣传重点应放在居民家庭饮食卫生上。
病原体检测结果中致病菌和诺如病毒的检出率分别在性别、年龄和职业各组中的差异均无统计学意义, 这与上海市宝山区监测结果一致[17]。进一步对病原体分析发现, 病原体中诺如病毒和致泻大肠埃希氏菌检出率均高于沙门氏菌和副溶血性弧菌, 这与上海多区及北京东城区结果一致[13,15,19-20], 但较金山区往年副溶血性弧菌占比较高的监测结果相比有所变化[11], 这可能与医生监测敏感性、检测人员检测能力和监测水平提升有关, 也间接反映上级食源性疾病监测点调整和能力培训有成效。
不同性别检出的主要致病菌不同, 男性以致泻大肠埃希氏菌和沙门氏菌为主, 女性以致泻大肠埃希氏菌和副溶血性弧菌为主, 这与我国研究相一致[9], 可能与男女饮食习惯差异有关。对年龄组合并后, 18~64岁病例组中致泻大肠埃希氏菌检出率在3种致病菌中最高, 表明致泻大肠埃希氏菌可能为辖区内主要散发病例的致病菌, 且该菌检出率在蔬菜水果类饮食暴露者的粪便样本中较高, 可能与夏秋季居民喜好生食蔬菜水果和荤素凉菜有关, 这些均为致泻大肠埃希氏菌污染的高风险食品, 警示居民应注意该类食物的清洁与注意生熟分开, 并提高降低交叉污染风险的意识。
本研究中致泻大肠埃希氏菌检出率(12.79%)明显高于周边沿海地区[21-24], 与上海市浦东新区食源性患者及全国门/急诊腹泻病患者检出水平相近[13,25], 且该菌优势血清型是粘附性大肠埃希氏菌属和产肠毒素大肠埃希氏菌属, 与上海、西安等地监测结果一致[26-27], 感染人群以18岁以上者为主(85.71%, 18/21), 这与上海市浦东新区研究结果存在差异[13], 可能与监测人群构成有关。沙门氏菌优势血清型为鼠伤寒沙门菌, 与国内多地监测结果一致[12,21]。副溶血性弧菌感染常见于暴发性食源性疾病事件, 志贺氏菌未检出, 这反映了南方沿海不是志贺氏菌的流行区。
致泻大肠埃希氏菌对氨苄西林和四环素耐药率及菌株多重耐药率均较高, 与国内多地结果相近[27-29]; 沙门氏菌对传统抗生素链霉素和氨苄西林耐药率依然较高[30]且多重耐药率高于致泻大肠埃希氏菌; 副溶血性弧菌对头孢唑林耐药率最高, 与章乐怡等[21]研究结果一致。食源性疾病病例中致病菌耐药现象普遍, 特别是沙门氏菌和致泻大肠埃希氏菌耐药情况较为严重, 一方面应在合理规范用药的前提下加强耐药性的持续监测, 为指导临床用药提供一定的科学依据, 另一方面, 由于养殖业不合理的使用抗菌药物, 可导致产生多重耐药沙门氏菌, 其耐药基因可通过水平转移的方式, 最终进入对人致病或机会性致病的病原体中, 因此对致病菌耐药性和耐药机制全面深入的认识, 可对研制新型抗菌药物提供新靶点以及临床联合用药治疗提供新思路[31]。
本研究为基于疾病负担评估食品安全风险的决策和监管提供了关键基础, 但也存在一定的局限性。新冠肺炎疫情监测常规化后, 2023年辖区主动监测哨点医院调整, 经市区级培训和指导哨点医院实验室检测能力大力提升, 4月份开始自主开展食源性疾病致病病原体检测工作, 故1—3月份检测数据缺乏可能对监测结果产生一定影响。其次, 主动监测的病例可能存在不完全是食源性传播引起的感染或者非感染性腹泻的病例。最后, 住院和死亡病例的比例因未被监测到而可能被低估。
基金
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  • 上海市金山区卫生健康专项面上科研项目(JSJK-KTMS-2021-06)
文献
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2025年第16卷第5期
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doi: 10.19812/j.cnki.jfsq11-5956/ts.20241017001
  • 接收时间：2024-10-17
  • 首发时间：2025-07-21
  • 出版时间：2025-03-15
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  • 收稿日期：2024-10-17
基金
上海市金山区卫生健康专项面上科研项目(JSJK-KTMS-2021-06)
作者信息
    1.上海市金山区疾病预防控制中心, 上海 201599
    2.山西医科大学公共卫生学院, 太原 030001

通讯作者:

* 邱服斌(1968—), 男, 博士, 教授, 主要研究方向为食品营养与慢性病预防。E-mail:
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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