艰难梭菌相关性腹泻患者50例临床特征及其病原菌耐药性分析  

Clinical characteristics and antimicrobial susceptibility of clostridium difficile associated diarrhea

作　　者：陈云波[1] 吴微珍[1] 鲁海峰[1] 杨介钻[1] 王保红[1] 孔海深[1] 李兰娟[1] 

机构地区：[1]浙江大学医学院附属第一医院传染病诊治国家重点实验室,杭州310003

出　　处：《浙江医学》2010年第11期1632-1634,1640,共4页Zhejiang Medical Journal

基　　金：国家重点基础研究发展计划（2007CB513003）

摘　　要：目的研究艰难梭菌相关性腹泻（CDAD）患者的临床特征及艰难梭菌的毒素基因和抗菌药物耐药性情况。方法对163例医院感染性腹泻患者采用选择性培养基培养艰难梭菌，用常规PCR法分别检测艰难梭菌毒素A、B的基因tcdA和tcdB，并根据检测结果分为CDAD组和非CDAD组，记录两组患者的临床特征；同时采用E—test法检测其中的产毒艰难梭菌对甲硝唑、万古霉素、利福平、克林霉素和莫西沙星的敏感性。结果在163份临床标本中共培养得到50株（30.7％）产毒艰难梭菌；两组在发热、水样便发生率和血清白蛋白水平方面的差异均有统计学意义（均P〈0.05）。A^＋B^＋为33株（66O％），A^-B^＋为17株（34．0％）；产毒株对甲硝唑、万古霉素、利福平、克林霉素和莫西沙星的耐药率分别为0％、0％、18％、68％和48％。结论艰难梭菌A^-B^＋菌株有较高的分离率，50株艰难梭菌均对甲硝唑和万古霉素敏感，但对克林霉素和莫西沙星耐药率较高。Objective To investigate the clinical characterizations and resistance to antibiotics of clostridium difficile associated diarrhea. Methods Clostridium difficile straits were selected by cycloserine-cefoxitin-fructose agar from fecal specimens of 163 patients with diarrhea The genes tcdA and tcdB of toxin A and B were detected by conventional PCR, The antibiotic resistance of toxic clostridium difficile to metronidazole, vancomycin, rifampicin, moxifioxacin and clindamycin was examined by E-test method. Results Fifty clinical strains of toxic clostridium difficile were isolated from 163 fecal specimens （30,7%）, in which 17 strains were A^-B^＋ and 33 strains were A^＋B^＋. All strains were susceptible to metronidazole and vancomycin. Resistance to rifammpicin, moxifloxacin and ctindamycin was found in 18%, 48% and 68% of the isolates respectively. Conclusion The clinical isolates of clostridium difficile in this study are all susceptible to metronidazole and vancomycin, but have high resistant rates to moxifloxacin and ctindamycin.

关 键 词：艰难梭菌相关性腹泻 毒素 抗菌药物耐药性 

分 类 号：R574.62[医药卫生—消化系统]