目的 调查并分析中南地区某市住院腹泻患者艰难梭菌感染情况及相关危险因素.方法 收集2020年10～12月湘南学院附属医院、附属第一医院和附属第三医院的住院腹泻患者粪便标本共306例,厌氧培养法分离艰难梭菌菌株,采用实时荧光定量PCR检测A、B毒素基因tcdA、tcdB及二元毒素基因cdtA、cdtB;16S r DNA确定无杂菌携带的艰难梭菌菌株,进行多位点序列分型(MLST);使用Etest条进行耐药性检测;以是否感染艰难梭菌为分组依据,比较分析住院腹泻患者艰难梭菌感染的危险因素.结果 住院腹泻患者产毒艰难梭菌感染率为8.17%(25/306),毒素基因均为tcdA+tcdB+,未检出二元毒素;分离出无杂菌携带艰难梭菌7株,5种ST型,分别为ST54 3株,ST129、ST98、ST53和ST631各1株,均位于clade1群;所有菌株对甲硝唑和万古霉素敏感.半年内住院史(OR=3.675,95%CI:1.405～9.612)、PPI用药史(OR=7.107,95%CI:2.575～19.613)、近1个月抗生素使用≥1周(OR=7.306,95%CI:2.274～23.472)、非甾体类抗炎药用药史(OR=4.754,95%CI:1.504～15.031)、患胃肠疾病(OR=5.050,95%CI:1.826～13.968)是腹泻患者艰难梭菌感染的危险因素.结论 目前该市住院腹泻患者艰难梭菌感染率水平不高,感染毒素类型为A+B+,基因型以clade1群和ST54型为主,对甲硝唑和万古霉素敏感.建议临床重视对有艰难梭菌感染危险因素暴露史的患者加强预防,减少艰难梭菌院内感染.
Objective To investigate the characteristics of Clostridioides difficile infection(CDI)in patients hospitalized for diarrhea and analyze the risk factors for CDI.Methods Stool samples were collected from 306 patients with diarrhea hospitalized in 3 university hospitals in a mid-south city of China from October to December,2020.C.difficile was isolated by anaerobic culture,and qRT-PCR was used to detect the expressions of toxin A(tcdA)and B(tcdB)genes and the binary toxin genes(cdtA and cdtB).Multilocus sequence typing(MLST)was performed for the isolated strains without contaminating strains as confirmed by 16S rDNA sequencing.Etest strips were used to determine the drug resistance profiles of the isolated strains,and the risk factors of CDI in the patients were analyzed.Results CDI was detected in 25(8.17%)out of the 306 patients.All the patients tested positive for tcdA and tcdB but negative for the binary toxin genes.Seven noncontaminated C.difficile strains with 5 ST types were isolated,including 3 ST54 strains and one strain of ST129,ST98,ST53,and ST631 types each,all belonging to clade 1 and sensitive to metronidazole and vancomycin.Hospitalization within the past 6 months(OR=3.675;95%CI:1.405-9.612),use of PPIs(OR=7.107;95%CI:2.575-19.613),antibiotics for≥1 week(OR=7.306;95%CI:2.274-23.472),non-steroidal anti-inflammatory drugs(OR=4.754;95%CI:1.504-15.031)in the past month,and gastrointestinal disorders(OR=5.050;95%CI:1.826-13.968)were all risk factors for CDI in the patients hospitalized for diarrhea.Conclusion The CDI rate remains low in the hospitalized patients with diarrhea in the investigated hospitals,but early precaution measures are recommended when exposure to the risk factors is reported to reduce the risk of CDI in the hospitalized patients.
周勇;吴媛;曾汇文;陈翠梅;谢群;贺莉萍
湘南学院公共卫生学院,湖南 郴州 423000中国疾病预防控制中心传染病预防控制所,北京 102206
艰难梭菌;毒素基因;多位点序列分型;耐药性;危险因素
Clostridioides difficile;toxin gene;multilocus sequence typing;drug resistance;risk factors
《南方医科大学学报》 2024 (005)
998-1003 / 6
国家传染病预防控制重点实验室独立研究开放课题(2021SKLID302);郴州市技术研发中心(郴科发[2021]57号)
10.12122/j.issn.1673-4254.2024.05.23
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