艰难梭菌分子分型与艰难梭菌感染分级的相关性研究

The correlation between the molecular typing of Clostridium difficile and the infection classification of Clostridium difficile

目的回顾性分析杭州市第一人民医院临床分离艰难梭菌菌株分子分型与艰难梭菌感染(CDI)严重程度相关性.方法对2016年3月至2017年5月860例腹泻粪便样本进行艰难梭菌毒素基因检测和MLST分型,结合患者临床信息分析艰难梭菌分子分型与其感染分级的相关性.结果共检出产毒型艰难梭菌94株,其中tcdA-tcdB+52株(55.3%).MLST分型共有15种,主要是ST37型25株(26.6%)和ST54型20株(21.3%).tcdA-tcdB+比tcdA+tcdB+患者白细胞数和肌酐更高,更易引起严重艰难梭菌感染(P<0.05).ST37型比其他ST型患者腹泻次数更多、白细胞数更高(P<0.05).结论艰难梭菌tcdA-tcdB+和ST37型与严重CDI相关,毒素基因检测和MLST分型可为艰难梭菌感染诊治提供依据.

Objective Retrospective analysis of the molecular typing results of clostridium difficile and clinical manifestations of C.difficile infection(CDI)in Hangzhou First People's Hospital.Methods A total of 860 samples of diarrhea feces were collected from March 2016 to May 2017.PCR technology was used to detect C.difficile toxin gene and MLST.Results A total of 94 strains of toxin—producing C.difficile were obtained by toxin genotyping,among which 52 strains of tcdA—tcdB+(55.3%,52/94).A total of 15 species of ST were detected by multi—locus sequence typing.The top three were 25 strains of ST37(26.6%,25/94)and 20 strains of ST54(21.3%,20/94).It was found that tcdA—tcdB+was more likely to cause severe CDI(P<0.05),compared with tcdA+tcdB+patients,with higher white blood cell count and creatinine level ST37 compared with other ST—type,diarrhea was more frequent and white blood cell count was higher(P<0.05).Conclusion The C.difficile toxin genes tcdA-tcdB+and ST37 are associated with severe CDI.Therefore,C.difficile toxin gene and MLST typing detection can provide reference for clinical timely and reasonable treatment.