抗生素相关性腹泻患者艰难梭菌和白色念珠菌检测与临床特征分析

The investigation of toxin-producing Clostridium difficile and Candida albicans in the patients with antibiotic-associated diarrhea

目的调查四川大学华西医院抗生素相关性腹泻(antibiotic-associated diarrhea,AAD)患者产毒艰难梭菌和白色念珠菌感染率,分析其临床特征并调查目前临床医师对AAD患者的治疗情况,为临床诊治提供参考依据。方法收集2014年9月-2015年1月四川大学华西医院AAD患者大便标本。通过聚合酶链反应检测并鉴定产毒艰难梭菌和白色念珠菌,收集患者临床资料并进行分析。结果 126例AAD患者中检测出艰难梭菌28例,其中产毒艰难梭菌者20例(15.9%),A^+B^+型35.7%(10/28),A^+B^+型35.7%(10/28),A^+B^+型28.6%(8/28)。检出酵母菌者54例(42.9%),其中白色念珠菌20.6%(26/126).光滑念珠菌8.7%(11/126),热带念珠菌7.9%(10/126),近平滑念珠菌2.4%(3/126),酿酒酵母1.6%(2/126),奥默柯达酵母菌0.8%(1/126),毕赤酵母菌0.89%(1/126)。其中2.4%(3/126)同时检测出产毒艰难梭菌和白色念珠菌。AAD患者使用的抗菌药物主要是青霉素类、碳青酶烯类、第3代头孢菌素类、喹诺酮类,均伴有不同程度的基础疾病。AAD患者临床上主要使用益生菌和蒙脱石散治疗。结论 AAD患者白色念珠菌和产毒艰难梭菌感染率较高,影响因素复杂,需加强临床医师对AAD的诊治意识。

Objective To investigate the infection rates of toxin-producing Clostridium difficile and Candida albicans in patients with antibiotic-associated diarrhea（AAD） in West China Hospital of Sichuan University, analyze their clinical characteristics and make a survey of the therapy. Methods Fecal specimens of AAD patients were collected in West China Hospital of Sichuan University from September 2014 to January 2015.Toxin-producing Clostridium difficile and Candida albicans were identified by polymerase chain reaction and then clinical data of cases was collected and analyzed. Results Twenty-eight patients with Clostridium difficile infection were detected from the 126 AAD patients, 20 patients（15.9%） in whom were infected with toxin-producing Clostridium difficile. Type A^＋B^＋, type A^-B^＋, and type A^＋B^＋ accounted for 35.7%（10/28）, 35.7%（10/28） and 28.6%（8/28）, respectively. Fifty-four patients（42.9%） with yeast infection were detected. The predominant isolate was Candida albicans, accounting for 20.6%（26/126）, and the others were Candida glabrata（n=11）, Candida tropical（n=10）, Candida parapsilosis（n=3）, Saccharomyces cerevisiae（n=2）, Pichia pastoris（n=1）, and Kodamaea ohmeri（n=1）. Toxin-producing Clostridium difficile strains and Candida albicans strains were both isolated from 3 patients（2.4%）. The main antibiotics used in AAD ppatients were penicillins, carbapenems,third generation cephalosporins, and fluoroquinolones. AAD patients were all with underlying diseases at different degrees. The main treatments were probiotics and montmorillonite powder. Conclusion The relatively high infection rates and complicated factors of AAD indicate that much more attention needs to be paid to the diagnosis and therapy of AAD by the clinical doctors.