严建新, 黄林瑶, 江天, 吕涛, 陈云波. 一家县级医院重症医学科住院患者艰难梭菌感染的分子流行病学调查研究[J]. 疾病监测, 2021, 36(4): 335-339. DOI: 10.3784/jbjc.202012240435
引用本文: 严建新, 黄林瑶, 江天, 吕涛, 陈云波. 一家县级医院重症医学科住院患者艰难梭菌感染的分子流行病学调查研究[J]. 疾病监测, 2021, 36(4): 335-339. DOI: 10.3784/jbjc.202012240435
Yan Jianxin, Huang Linyao, Jiang Tian, Lyu Tao, Chen Yunbo. Molecular epidemiology of Clostridioides difficile isolated from patients in ICU of a county-level hospital[J]. Disease Surveillance, 2021, 36(4): 335-339. DOI: 10.3784/jbjc.202012240435
Citation: Yan Jianxin, Huang Linyao, Jiang Tian, Lyu Tao, Chen Yunbo. Molecular epidemiology of Clostridioides difficile isolated from patients in ICU of a county-level hospital[J]. Disease Surveillance, 2021, 36(4): 335-339. DOI: 10.3784/jbjc.202012240435

一家县级医院重症医学科住院患者艰难梭菌感染的分子流行病学调查研究

Molecular epidemiology of Clostridioides difficile isolated from patients in ICU of a county-level hospital

  • 摘要:
      目的  研究县级医院重症医学科(ICU)住院患者艰难梭菌的感染现状,探讨产毒素菌株的分子流行病学特点。
      方法  收集2017年12月至2019年12月于浙江省温岭市第一人民医院ICU住院并发生腹泻患者的粪便样本,分离培养艰难梭菌并进行毒素基因检测和PCR核糖体分型。
      结果  共收集355份非重复患者粪便样本,分离到产毒素艰难梭菌32株,分离率为9.01%(32/355)。 其中毒素A、B基因均阳性(A+B+)的菌株30株,占93.75%(30/32);毒素A基因阴性但毒素B基因阳性(A-B+)菌株2株,占6.25%(2/32)。 30株A+B+菌株中,二元毒素(CDT)基因阳性(A+B+CDT+)菌株3株,占9.38%(3/32)。 成年组和儿童组患者中,艰难梭菌感染(CDI)组与非感染组在年龄、性别、外周血白细胞数、肝功能和肾功能相关参数的差异无统计学意义。 成年组CDI患者主要发生在夏季。 PCR核糖体分型将32株产毒素艰难梭菌分成8个克隆群,其中4个克隆群占81.25%。
      结论  县级医院ICU的CDI发生率较高,应加强基层医院CDI监测。

     

    Abstract:
      Objective  To understand the infection status of Clostridioides difficile in the intensive care unit (ICU) of a county-level hospital in Zhejiang, and discuss the molecular epidemiological characteristics of toxin producing strains of C. difficile.
      Methods  Stool samples were collected from the ICU patients with diarrhea in The First People′s Hospital of Wenling from December 2017 to December 2019. C. difficile isolates were subjected to polymerase chain reaction (PCR) for detection of toxin genes. PCR ribosomal typing was used for genotyping of the C. difficile strains.
      Results  A total of 355 stool samples were collected, in which 32 (9.01%) were positive for toxigenic C. difficile. Toxin gene profiling revealed that in the 32 isolates 30 (93.75%) were positive for both toxin A (tcdA) and toxin B (tcdB) (A+B+), 2 (6.25%) were toxin A negative and toxin B positive (A-B+), and 3 (9.38%) were positive for both cdtA and cdtB genes (A+B+CDT+). In adults and children with diarrhea, the differences in age, gender, peripheral blood leucocyte, liver function indicator and renal function indicator were not significant between C. difficile infection group and non-C. difficile infection group. C. difficile infection mainly occurred in summer in adults. A total of 8 groups of PCR ribotypes (RTs) were identified based on the molecular epidemiology study.
      Conclusion  The study results indicated that the incidence of C. difficile infectionin in ICU of county-level hospitals was high, so it is necessary to strengthen C. difficile infection surveillance in grassroots hospitals.

     

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