某院精神科住院患者艰难梭菌定植的分子流行病学特征  

Molecular epidemiological characteristics of Clostridioides difficile colonization in psychiatric inpatients in a hospital

作　　者：王玲 林珊 黄益花 段慈东 田梦伦 沈宇航 宋小军 陈毓 赵龙友 金大智 Wang Ling;Lin Shan;Huang Yihua;Duan Cidong;Tian Menglun;Shen Yuhang;Song Xiaojun;Chen Yu;Zhao Longyou;Jin Dazhi(Lishui Second People's Hospital,Lishui 323020;TEDA Institute of Biological Sciences and Biotechnology,Nankai University,Tianjin 300457;School of Laboratory Medicine and Bioengineering,Hangzhou Medical College,Hangzhou 310053;Institute of Ageing Research,School of Basic Medical Sciences,Hangzhou Normal University,Hangzhou 311121;Key Laboratory of Biomarkers and in vitro Diagnosis Translation of Zhejiang Province,Hangzhou 310063;Laboratory Medicine Center,Department of Clinical Laboratory,Zhejiang Provincial People's Hospital,Hangzhou Medical College,Hangzhou 310014)

机构地区：[1]丽水市第二人民医院,丽水323020 [2]南开大学泰达生物技术研究院,天津300457 [3]杭州医学院检验医学院,生物工程学院,杭州310053 [4]杭州师范大学基础医学院,杭州311121 [5]浙江省生物标志物与体外诊断转化重点实验室,杭州310063 [6]浙江省人民医院杭州医学院附属人民医院检验中心,杭州310014

出　　处：《中国抗生素杂志》2024年第5期584-592,共9页Chinese Journal of Antibiotics

基　　金：国家自然科学基金项目(No.82372299);浙江省自然科学基金重点项目(No.LXZ22H300001);杭州医学院基础科研项目(No.KYZD202004,No.KYYB2023003);浙江省医药卫生科技计划项目(No.2019KY252);丽水市重点研发计划(No.2017ZDYF15)。

摘　　要：目的研究精神科住院患者艰难梭菌定植的分子流行病学特征,并探讨定植的相关因素。方法于2020年6月1日至9月30日期间,收集丽水市第二人民医院精神科住院患者的粪便样本。分离培养艰难梭菌,并进行毒素基因鉴定、多位点序列分型和抗生素敏感性试验。结合患者的临床资料,分析艰难梭菌定植的相关因素。结果共收集粪便样本442份,分离到24株(5.4%)艰难梭菌。其中,20株为TcdA和TcdB毒素基因阳性、二元毒素基因阴性(A+B+CDT-),3株为A-B+CDT-,1株为A+B+CDT+。共鉴定出14种序列分型(ST),包括1株高毒力ST11型。所有菌株对甲硝唑、万古霉素、利福平和哌拉西林敏感,但对环丙沙星(95.8%)、克林霉素(87.5%)和红霉素(62.5%)的耐药率较高。二元Logistic回归分析结果显示,在不同科室中,年龄(≥60岁)、住院天数(>200 d)和服用劳拉西泮片与老年精神科患者艰难梭菌定植具有显著相关性(OR=3.762~15.556,P<0.05),而住院天数(>20 d)与早期干预科患者艰难梭菌定植具有显著相关性(OR=0.004,P<0.001)。结论研究发现精神科住院患者存在5.4%的艰难梭菌定植率,年龄较大、住院天数较长且长期服用精神治疗性药物的患者与艰难梭菌定植间存在相关性,需加强院内感染防控监测进而遏制艰难梭菌在精神科的暴发和传播。Objective To investigate the molecular epidemiology of Clostridioides difficile colonization(CDC) in psychiatric inpatients and explore the associated factors.Methods Stool samples were collected from psychiatric inpatients in Lishui Second People's Hospital between June 1 and September 30,2020.C.difficile was cultured and analyzed for toxin gene identification,multilocus sequence typing,and antimicrobial resistance.Associated factors for CDC were analyzed according to patients' clinical data.Results Out of 442 stool samples,24(5.4%)C.difficile isolates were obtained.Among them,20 isolates were identified as TcdA and TcdB positive and binary toxin genes negative(A+B+CDT-),three as A-B+CDT-,and one as A+B+CDT+.Fourteen sequence types(ST) were identified,including one hypervirulent ST11.All isolates were susceptible to metronidazole,vancomycin,rifampin,and piperacillin,but exhibited high resistance rates to ciprofloxacin(95.8%),clindamycin(87.5%),and erythromycin(62.5%).Binary logistic regression results showed that in different departments,age(≥60 years),length of hospital stays(>200 days),and lorazepam usage were significantly associated with CDC(OR=3.762~15.556,P<0.05).In contrast,there was a significant association between length of hospital stays(>20 days) and CDC(OR=0.004,P<0.001).Conclusion The study revealed a 5.4% colonization rate among psychiatric inpatients.There is a correlation between older age,prolonged hospitalization,and long-term usage of psychotropic medications with CDC.Monitoring and controlling nosocomial infection should be enforced to prevent the outbreak and transmission of C.difficile in this hospital.

关 键 词：艰难梭菌定植 精神科 分子特征 相关因素 

分 类 号：R978.1[医药卫生—药品]