103株艰难梭菌毒素基因检测及其流行病学意义

Toxin gene detection and epidemiological significance of 103 strains of Clostridium difficile

目的通过对本院住院患者粪便标本艰难梭菌培养和毒素分型,了解其感染情况及毒素型别。方法收集2021年1月—6月1000份患者粪便标本,对培养阳性并经质谱确认菌株应用PCR扩增法检测毒素A基因、B基因以及二元毒素基因。结果艰难梭菌培养阳性标本103份,阳性率为10.3%;患者平均年龄为60.3岁,平均住院天数为26.6 d。PCR检测产毒素tcd(A+B+)型67例(占65.1%);tcd(A-B+)型16例(占15.5%);tcd(A-B-)型20例(占19.4%),二元毒素(CDT)均为阴性。tcd(A+B+)型、tcd(A-B+)型、tcd(A-B-)型血液科分别有18例、4例、4例;消化科分别有16例、3例、2例。产毒素A+B+型粪便隐血试验结果≥1+的阳性率为27.3%,患者使用喹诺酮占比35.4%。结论本院艰难梭菌及毒素阳性者以老年患者居多,对有高危因素患者应加强检测和预防。同时临床抗感染应合理使用广谱抗生素,减少艰难梭菌的发病率。

Objective Through the cultivation and toxin typing ofClostridium difficilein fecal samples of hospitalized patients,the prevalence ofClostridium difficileinfection and the epidemic situation of the toxin will be known.Methods A total of 1000 fecal samples of clinical inpatients in our hospital from January to June 2021 were collected for anaerobic culture ofClostridium difficile,and then Polymerase chain reaction(PCR)was used to detect toxin A gene,toxin B gene and binary toxin gene of the bacterial strain which is positive and confirmed by mass spectra.Results Among 1000 fecal samples,103 wereClostridium difficilepositive(culture positive rate 10.3%);the average age of patients is 60.3 years old,the average length of stay is 26.6 days.Among the PCR results,67 cases(65.1%)aretcd(A+B+),16 cases(15.5%)aretcd(A-B+)and 20 cases(19.4%)aretcd(A-B-).Binary toxin is negative in all samples.The cases oftcdA+B+type,tcdA-B+type,tcdA-B-type are successively 18 cases,4 cases and 4 cases in the Department of Hematology;16 cases,3 cases and 2 cases in the Digestive Department.The fecal occult blood positive rates oftcd(A+B+)type was 27.3%.The proportion of patients using quinolone was 35.4%.Conclusion The majority of the patients withClostridium difficileculture positive and toxin positive were elderly patients.The patients with high risk factors should be detected and prevented.At the same time,broad-spectrum antibiotics should be reasonably used to reduce the incidence ofClostridium difficile.