消化系统疾病患者难辨梭状芽胞杆菌感染后肠道菌群变化  

Changes of intestinal microbiota in patients with digestive system diseases with Clostridium dif ficile infection

作　　者：张妙芬 温庆辉 黎志勤 钟佩君 李华 ZHANG Miao-fen;WEN Qing-hui;LI Zhi-qin;ZHONG Pei-jun;LI Hua(The 10th Affiliated Hospital of Southern Medical University,Dongguan People's Hospital,Dongguan,Guangdong 523059,China;不详)

机构地区：[1]南方医科大学第十附属医院东莞市人民医院检验科,广东东莞523059 [2]中山大学附属东华医院检验科,广东东莞523050

出　　处：《中华医院感染学杂志》2024年第16期2444-2447,共4页Chinese Journal of Nosocomiology

基　　金：国家重点研发计划“重大慢性非传染性疾病防控研究”重点专项2018年度项目(2018YFC1315400)。

摘　　要：目的 评估难辨梭状芽胞杆菌感染(CDI)消化系统疾病患者肠道菌群变化,以期为临床诊治提供参考。方法 纳入东莞市人民医院于2020年6月-2023年6月收治的189例医院获得性腹泻消化疾病患者的资料,按照难辨梭状芽胞杆菌感染(CDI)阳性与阴性1∶2匹配分组(63例∶126例),检验艰难梭菌分离物,进行临床培养,鉴定病原菌及药敏,对难辨菌分离株进行基因分型并与临床结果进行比较,使用实时定量聚合酶链反应(PCR)检测肠道微生物组的细菌靶点。结果 189例消化疾病患者中检出51株艰难梭菌,其中23株为产毒菌株;18.3%(22/120)的皮肤和环境样本显示艰难梭菌定植阳性结果;低浓度的甲硝唑和万古霉素[最低抑菌浓度(MIC)90、0.5和1.2 mg/L]对所有产毒艰难梭菌均有抑制作用;此外,这些菌株对莫西沙星和克林霉素的耐药率最高(MIC 90、0.5和1.6 mg/L);消化疾病组患者与健康对照组菌种比较差异均有统计学意义(P<0.05);且除双歧杆菌属、肠球菌外,CDI消化疾病组患者与非CDI消化疾病组患者菌种亦存在差异(P<0.05);CDI消化疾病组患者厚壁菌门载量高于非CDI消化疾病组(P<0.05),而非CDI消化疾病组高于健康对照组(P<0.05);就拟杆菌门载量而言,健康对照组>非CDI消化疾病组>CDI消化疾病组,差异均有统计学意义(P<0.05)。结论 尽管消化系统疾病重症监护病房采取了适当的感染控制策略,但CDI在严重消化疾病患者中仍然很普遍。CDI消化疾病患者中黏液弧菌过度生长和普氏金黄色葡萄球菌丰度降低可能是消化疾病患者潜在的微生物组生物标志物。OBJECTIVE To evaluate the changes of intestinal microflora in patients with digestive diseases infected with Clostridium difficile(CDI),in order to provide reference for clinical diagnosis and treatment.METHODS Data of 189 patients with hospital-acquired diarrhea admitted to Dongguan People's Hospital from Jun 2020 to Jun 2023 were included and divided into two groups according to the detection results of C.difficile-positive and-negative at the ratio of 1:2(63 cases:126 cases).The isolates of C.difficile was detected and cultured for pathogen identification.And the drug susceptibility was detected.The correlation between genotypes and the clinical results was analyzed.Real-time quantitative polymerase chain reaction(PCR)was used to detect bacterial targets in the gut microbiome.RESULTS Totally 51 strains of C.dif ficile were detected in 189 patients with digestive diseases,of which 23 were virus-producing strains.18.3%(22/120)of skin and environmental samples showed positive results for C.dif ficile colonization.Low concentrations of metronidazole and vancomycin[minimum inhibitory concentration(MIC)90,0.5 and 1.2 mg/L] inhibited all toxogenic C.difficile.In addition,these strains showed the highest rates of resistance to moxifloxacin and clindamycin(MIC 90,0.5 and 1.6 mg/L).There were significant differences in bacterial species between digestive disease group and healthy control group(P<o.05).In addition to bifidobacterium and enterococcus,there were also differences in bacterial species between CDI digestive disease group and non-CDI digestive disease group(P<0.05).The load of firmicutes in CDI digestive disease group was higher than that in non-CDI digestive disease group(P<0.05),while that in non-CDI digestive disease group was significantly higher than that in healthy control group(P<o.05).In terms of bacteroidetes loading,the healthy control group was>non-CDI digestive disease group>CDI digestive disease group,and the differences were statistically significant(P<O.05).CONCLUSION Despite appropriate infecti

关 键 词：难辨梭状芽胞杆菌感染 肠道菌群 普氏金黄色葡萄球菌 消化系统疾病 产毒艰难梭菌 

分 类 号：R378.8[医药卫生—病原生物学]