重症监护室腹泻患者中艰难梭菌感染的基因分型及耐药性分析  

Genotyping and drug-resistance analysis of Clostridium difficile in diarrhea patients from ICU

作　　者：应建飞 汪一萍 俞燕红 鲁勇 贺明阳 YING Jian-fei;WANG Yi-ping;YU Yan-hong;LU Yong;HE Ming-yang(Clinical Laboratory,Yinzhou People＇s Hospital,Ningbo,Zhejiang 315040,China)

机构地区：[1]宁波鄞州人民医院检验科

出　　处：《中国卫生检验杂志》2018年第22期2766-2768,2772,共4页Chinese Journal of Health Laboratory Technology

摘　　要：目的 探讨艰难梭菌在ICU腹泻患者中的检出率、耐药率、基因型,为临床防治艰难梭菌感染提供科学依据。方法 对2015年4月-2017年6月本院ICU中发生腹泻的患者,进行粪便的艰难梭菌分离鉴定,并通过PCR方法检测其毒素基因;对产毒艰难梭菌进行多位点序列分型和用E-test进行药敏试验。结果 在314份无重复标本中分离得到65株产毒素艰难梭菌,其中毒素A阴性、毒素B阳性的菌株（A-B＋）有14株（21. 5%,14/65）,毒素A和毒素B菌均为阳性的菌株（A＋B＋）有51株（78. 5%,51/65）;共有15种ST型,其中ST-54、ST-37、ST-3、ST-35和ST-8为主要的ST型,分别占23. 1%、16. 9%、12. 3%、9. 2%和9. 2%。产毒素艰难梭菌对甲硝唑、万古霉素敏感。结论 艰难梭菌感染在本院ICU患者中较为常见,其主要流行菌株与国内其他报道相类似;临床应加强对艰难梭菌的监测,万古霉素和甲硝唑可作为艰难梭菌感染的首选经验用药。Objective To investigate the detection rate, resistance rate and genotype of Clostridium difficile in diarrhea patients from ICU, so as to provide scientific basis for clinical prevention and treatment of Clostridium diJficile infection. Methods Stool samples collected from diarrhea patients during April 2015 - June 2017 from ICU were conducted for the isolation and identification of C. difficile. Toxin genes were detected by PCR. Muhilocus sequence typing was performed on toxigenic C. difficile and suscep- tibility test was conducted by E - test. Results A total of 65 non - duplicate toxigenic C. diJficile isolates were identified from 314 non -duplicated specimen, including 14 strains negative to tcd A and positive to tcd B（ A -B ＋ ） , 51 strains both positive to tcd A and tcd B（A ＋ B ＋ ）. There were 15 ST types, of which ST - 54, ST - 37, ST - 3, ST - 35 and ST - 8 were the main ST types, accounting for 23.1%, 16.9%, 12.3%, 9.2% and 9.2%, respectively. The toxin -producing C. difficile was sensitive to metronidazole and vancomycin. Conclusion C. difficile infection was common in diarrhea patients from ICU. The main epi- demic strains are similar to other reported strains in China. The surveillance on Clostridium difficile should be strengthened in din- ic. Vancomvcin and metronidazole can be used as the first choice for Clostridium difffcile infection.

关 键 词：艰难梭菌感染 重症监护室 分子分型 抗生素谱 

分 类 号：R446.5[医药卫生—诊断学]