上海地区住院人类免疫缺陷病毒感染患者中艰难梭菌的检测及其意义  

Clinical characterization of Clostridium difficile-associated diarrhea in human immunodeficiency virus-infected inpatients in Shanghai

作　　者：金鑫[1] 钱雪琴[1] 胡绿荫[1] 李昕[1] 沈芳[1,2] 

机构地区：[1]上海市公共卫生临床中心医学检验科,上海201508 [2]上海市第五人民医院检验科,上海200240

出　　处：《微生物与感染》2015年第5期282-287,共6页Journal of Microbes and Infections

基　　金：复旦大学感染性疾病实验诊断(复医科办字[2012]1号)

摘　　要：为了解上海地区住院人类免疫缺陷病毒(HIV)感染患者中艰难梭菌相关性腹泻(CDAD)的发生率、临床特征、药敏及分型情况,收集250例住院HIV感染腹泻患者的粪便,用选择性培养基进行艰难梭菌和一般肠道致病菌分离;用E-Test法测定艰难梭菌对甲硝唑、万古霉素、克林霉素、莫西沙星的敏感度;用多位点序列分型法(MLST)和聚合酶链反应(PCR)检测菌株基因类型及细菌毒素基因tcdA和tcdB。结果共检出29株(11.6%)艰难梭菌,均对甲硝唑、万古霉素敏感,对莫西沙星和克林霉素的耐药率分别为31.0%和69.0%。MLST分型共检出12种ST型别(ST-2、-3、-7、-8、-26、-35、-37、-38、-39、-54、-81和-124),其中ST-54(6/29,20.7%)和ST-39(5/29,17.2%)是主要流行亚型;毒素基因tcdA+/tcdB+17株(17/29,58.6%),毒素基因tcdA-/tcdB-12株(12/29,41.4%),未检出毒素基因tcdA-/tcdB+菌株。结果提示,上海地区住院HIV感染腹泻患者粪便标本中艰难梭菌的分离率较高,需严密监控以防暴发流行。To investigate Clostridium-difficile （C. difficile ）-associated diarrhea （CDAD） in human immunodeficiency virus （HIV）-infected inpatients in Shanghai, C. difficile and general intestinal tract pathogenic bacteria were isolated by selective medium from abnormal fecal specimens collected from 250 HIV-infected inpatients from March 2012 to March 2013. The susceptibilities of C. difficile to metronidazole, vancomycin, clindamycin and moxifloxacin were determined by E-test method. Molecular typing was performed by multi-locus sequence typing （MLST）. The genes tcdA and tcdB of toxins A and B were detected by conventional polymerase chain reaction （PCR）. 29 clinical strains of C. difficile were isolated from 250 fecal specimens （11.6%）, in which 17 strains were tedA＋/tcdB＋ and 12 strains were tcdA- /tcdB -. All strains were susceptible to metronidazole and vancomycin. Resistance to clindamycin and moxifloxacin was found in 69.0% and 31.0% strains respectively. A total of 12 different sequence types （ST-2, -3, -7, -8, -26, -35, -37, -38, -39, -54, -81, and -124） were identified. The most prevalent ST types were ST-54 （6/29, 20.7%） and ST-39 （5/29, 17.2%）. The results suggest that the rate of positive C. difficile detection is high and should be monitored strictly to prevent outbreak.

关 键 词：人类免疫缺陷病毒 艰难梭菌相关性腹泻 毒素 药敏试验 多位点序列分型 

分 类 号：R440[医药卫生—诊断学] R512.91[医药卫生—临床医学]