临床腹泻患者艰难梭菌的感染情况和分子流行特征

The Clostridium difficile infection conditions and molecular epidemic characteristics of clinical diarrhea patients

目的了解临床腹泻患者艰难梭菌的感染情况和分子流行特征,为控制医院感染和临床诊疗提供依据。方法收集2016年1～12月浙江省嘉兴市第二医院临床腹泻患者粪便标本852份作为实验组,同期健康体检成人粪便标本310份作为对照组,厌氧培养获得艰难梭菌的阳性率,并结合毒素基因型和多位点序列分型进行综合分析。结果实验组852份粪便标本中共分离到108株艰难梭菌,阳性率为12.68%,而对照组310份粪便标本分离到8株,阳性率为2.58%,两组比较差异有统计学意义(P <0.05);实验组以tcdA+tcdB+菌株为主,占86.11%(93/108),tcd AtcdB+菌株占5.56%(6/108),tcdA-tcdB-菌株占8.33%(9/108),产毒率为91.67%,而对照组对应毒素基因型别占比为62.50%(5/8),12.50%(1/8),25.00%(2/8),产毒率为75.00%,但两组产毒率比较差异无统计学意义(P> 0.05);实验组多位点序列分型发现32种ST型,其中ST54是相对流行的型别,另外CC48是相对流行的克隆群。结论临床腹泻患者艰难梭菌的感染率较高,亟需引起临床重视并加强院感防控,预防暴发流行。

Objective To understand the infection conditions and molecular epidemic characteristics of Clostridium difficile in clinical patients with diarrhea,to provide a basis for controlling nosocomial infections and clinical diagnosis and treatment.Methods Eight hundred and fifty-two feces samples from clinical diarrhea patients in the Second Hospital of Jiaxing City from January to December2016were collected as experimental group and310feces samples from healthy examination adults in the same period were collected as control group.The positive rate of Clostridium difficile was obtained by anaerobic culture and taken comprehensive analysis by combining with toxin genotype and multilocus sequence typing.Results A total of108Clostridium difficile were isolated from852feces samples of experiment group,with a positive rate of12.68%,while a total of8Clostridium difficile were isolated from310feces samples of control group,with a positive rate of2.58%,the difference between the two groups was statistically significant(P<0.05).The experiment group was dominated by tcdA+tcdB+strains,accounted for86.11%(93/108),tcdA-tcdB+strains accounted for5.56%(6/108),and tcdA-tcdB-strains accounted for8.33%(9/108),the rate of toxin production was91.67%,while the corresponding toxin genotypes of the control group accounted for62.50%(5/8),12.50%(1/8),25.00%(2/8),and the rate of toxin production was75.00%,the rate of toxin production between the two groups had no statistically significant difference(P>0.05).In the experiment group,32ST types were found by multisite sequence typing,among which,ST54was a relatively popular type,while CC48was a relatively popular clonal complex.Conclusion The infection rate of Clostridium difficile in clinical patients with diarrhea is high,which is urgent to attract clinical attention and strengthen the prevention and control of the hospital infection,to prevent epidemic outbreak.