张文竹, 吴庆, 李文革, 王媛媛, 贾筱溪, 卢金星, 吴媛. 5岁以下腹泻患者分离的艰难梭菌分子型别和耐药特征分析[J]. 疾病监测, 2021, 36(4): 329-334. DOI: 10.3784/jbjc.202012170424
引用本文: 张文竹, 吴庆, 李文革, 王媛媛, 贾筱溪, 卢金星, 吴媛. 5岁以下腹泻患者分离的艰难梭菌分子型别和耐药特征分析[J]. 疾病监测, 2021, 36(4): 329-334. DOI: 10.3784/jbjc.202012170424
Zhang Wenzhu, Wu Qing, Li Wenge, Wang Yuanyuan, Jia Xiaoxi, Lu Jinxing, Wu Yuan. Molecular characteristics and antibiotic resistance of Clostridioides difficile isolated from patients with diarrhea under 5 years old[J]. Disease Surveillance, 2021, 36(4): 329-334. DOI: 10.3784/jbjc.202012170424
Citation: Zhang Wenzhu, Wu Qing, Li Wenge, Wang Yuanyuan, Jia Xiaoxi, Lu Jinxing, Wu Yuan. Molecular characteristics and antibiotic resistance of Clostridioides difficile isolated from patients with diarrhea under 5 years old[J]. Disease Surveillance, 2021, 36(4): 329-334. DOI: 10.3784/jbjc.202012170424

5岁以下腹泻患者分离的艰难梭菌分子型别和耐药特征分析

Molecular characteristics and antibiotic resistance of Clostridioides difficile isolated from patients with diarrhea under 5 years old

  • 摘要:
      目的  分析中国部分地区5岁以下腹泻患儿分离的艰难梭菌的分子型别和耐药特征,为后续研究及临床用药提供数据支持。
      方法  收集2010 — 2020年云南、山东、上海、陕西、河南和北京6省市5岁以下腹泻患儿的粪便标本,通过厌氧培养分离和鉴定艰难梭菌。 使用聚合酶链式反应(PCR)方法进行毒素基因检测、多位点序列分型(MLST)和核糖体分型,采用Etest条测定其对10种药物的耐药性。
      结果  分离的99株艰难梭菌中,ST3、ST54、ST35为主要型别,以tcdA+tcdB+cdtA-cdtB-菌株为主;RT012/ICDC007/ST54型菌株最为常见,1株菌为RT078/ICDC028/ST11。 所有菌株均对万古霉素和甲硝唑敏感,7株多重耐药菌株均来自<2岁患者,tcdA-tcdB+分离株中的多重耐药菌株数远高于tcdA+tcdB+菌株数(P=0.008)。
      结论  5岁以下腹泻患儿分离的艰难梭菌多为产毒株,其中包括ST37型(tcdA-tcdB+)和来自<2岁患儿的高毒株RT078型,提示应加强家庭和医院的双向保护,积极开展艰难梭菌的检测监测和预防控制。

     

    Abstract:
      Objective  To understand the molecular characteristics and antibiotic resistance of Clostridioides difficile isolated from patients with diarrhea under 5 years old and provide basic data support for future research and clinical medication of C. difficile infection treatment in children.
      Methods  From 2010 to 2020, stool samples were collected from the patients with diarrhea under 5 years old in Yunnan, Shandong, Shanghai, Shaanxi, Henan and Beijing. Anaerobic culture was used to isolate and identify C. difficile strains. The multilocus sequence typing, tcdA, tcdB, binary toxin coding gene detection as well as ribotyping were performed by polymerase chain reaction (PCR). And the antibiotic resistance test was performed by Etest strips against 10 antibiotics.
      Results  Among the 99 strains of C. difficile isolated, ST3, ST54, and ST35 were the major types, tcdA + tcdB + cdtA - cdtB - was predominant type. Type RT012/ICDC007/ST54 was the most common type, and one highly virulent strain belonged to type RT078/ICDC028/ST11. All the strains were sensitive to vancomycin and metronidazole, and 7 isolates from children under 2 years old were confirmed as multidrug resistant (MDR). There were more tcdA-tcdB+isolates than tcdA+tcdB+isolates in MDR isolates (P=0.008).
      Conclusion  Most toxigenic C. difficile were isolated from patients with diarrhea under 5 years old, including ST37 (tcdA-tcdB+), and the hyper virulent C. difficile (RT078) from children under 2 years old. It is necessary to pay close attention to the protection both at family and in hospital. The detection, prevention and control of C. difficile infection needs to be further strengthened in the children by taking targeted measures.

     

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