陕西省某三甲医院艰难梭菌分子流行特征及耐药情况分析

Molecular epidemiological characteristics and antibiotic resistance of Clostridioides difficile in a tertiary hospital in Shaanxi Province

目的了解陕西省某三甲医院住院腹泻患者中艰难梭菌(Clostridioides difficile,Cd)分子流行特点及耐药情况。方法收集2018年10月—2021年12月425份住院腹泻患者的粪便标本进行艰难梭菌分离鉴定,检测其毒素基因并进行多位点序列分型和E^(-)test药敏试验。结果425份标本中分离到49株艰难梭菌,产毒艰难梭菌37株,占75.5%(37/49),≥65岁腹泻患者Cd检出率为14.0%(25/179),肾内科Cd检出率为36.4%(4/11),A^(-)B^(+)CDT^(-)有7株,占18.9%(7/37),A^(+)B^(+)CDT^(-)有29株,占78.4%(29/37),A^(+)B^(+)CDT^(+)有1株,占2.7%(1/37);共有24个ST型别,其中ST2、ST3和ST54为主要检出型别,各占比为12.2%(6/49)。所有菌株对甲硝唑和万古霉素均敏感,对环丙沙星耐药率较高为93.9%(46/49),对利福平和美罗培南耐药率较低,分别为12.2%(6/49)和10.2%(5/49)。结论产毒株以A^(+)B^(+)CDT^(-)为主要型别,ST2、ST3和ST54为主要型别,各ST型别分布分散,全部菌株对甲硝唑和万古霉素敏感,大部分菌株对环丙沙星耐药。

Objective To investigate the molecular epidemiological characteristics and antibiotic resistance of Clostridioides difficile(Cd)in hospitalized diarrhea patients in a tertiary hospital in Shaanxi Province.Methods This study collected 425 stool samples of hospitalized diarrhea patients from October 2018 to December 2021 for isolation and identification of Cd.Toxin genes carried by the isolates were detected.Multilocus sequence typing(MLST)was performed to analyze the phylogenetic profile.Antibiotic susceptibility was analyzed by E^(-)test.Results Forty^(-)nine strains of Cd were isolated from the 425 samples,including 37 strains of toxigenic Cd(75.5%,37/49).The detection rate of Cd was 14.0%(25/179)in diarrhea patients aged≥65 years old and 36.4%(4/11)in Nephrology Department.In the 37 toxigenic Cd strains,A^(-)B^(+)CDT^(-)Cd,A^(+)B^(+)CDT^(-)Cd and A^(+)B^(+)CDT^(+)Cd accounted for 18.9%(7/37),78.4%(29/37)and 2.7%(1/37),respectively.There were 24 ST types,among which ST2,ST3 and ST54 were the predominant types,each accounting for 12.2%(6/49).All strains were sensitive to metronidazole and vancomycin,with a high resistance rate of 93.9%(46/49)to ciprofloxacin and a low resistance rate of 12.2%(6/49)and 10.2%(5/49)to rifampicin and meropenem,respectively.Conclusions The main type of toxigenic strains was A^(+)B^(+)CDT^(-).ST2,ST3 and ST54 were the predominant types and the distribution of ST types was scattered.All isolates were sensitive to metronidazole and vancomycin and most of them were resistant to ciprofloxacin.