湖州市某三甲医院住院患者艰难梭菌毒素基因检测及其分子流行病学分析  

Toxin gene detection and molecular epidemiology of Clostridioides difficile isolated from hospitalized patients in a tertiary hospital in Huzhou

作　　者：郑莉莉 强鑫华 嵇龙飞 Zheng Lili;Qiang Xinhua;and Ji Longfei(Department of Laboratory Medicine,the First People's Hospital of Huzhou,Huzhou 313000)

机构地区：[1]湖州市第一人民医院检验科,湖州313000

出　　处：《中国抗生素杂志》2025年第2期129-136,共8页Chinese Journal of Antibiotics

基　　金：湖州市科技局项目(No.2023GYB19)。

摘　　要：目的研究地市级医院住院患者艰难梭菌感染的发生情况,并分析艰难梭菌的分子流行病学特征。方法收集湖州市第一人民医院2023年11月—2023年12月住院腹泻患者粪便标本,培养分离艰难梭菌后,采用核酸扩增技术检测毒素基因,菌株经全基因测序后(Whole Genome Sequencing,WGS)进行分子流行病学分析。结果从500份住院患者腹泻样本中分离得到49株艰难梭菌,其中产毒型艰难梭菌40株,艰难梭菌感染(Clostridium difficile infections,CDI)阳性率为8.00%;PCR检测的毒素基因主要为tcdA(+)/tcdB(+),双毒素基因阴性(A+B+CDT-),占97.50%(39/40),1株携带双毒素基因(A+B+CDT+);CDI阳性率最高的科室是消化内科,其次为ICU;MLST分型中,共有13种ST型别,其中ST2型为优势型别,占30.00%;结合WGS数据分析,未发现艰难梭菌菌株在研究期间发生流行和传播。结论本院CDI在住院腹泻患者中的发生率较低,未发生院内感染传播和暴发流行现象,但不排除存在未知感染源可能性,应重点关注重点科室,如ICU患者发生CDI情况。Objective To study the incidence of Clostridioides difficile infection(CDI)in hospitalized patients in a tertiary hospital and analyze the molecular epidemiological characteristics of C.difficile.Methods Stool specimens from hospitalized patients with diarrhea in the First People’s Hospital of Huzhou City from November 2023 to December 2023 were collected.After C.difficile was isolated and confirmed,polymerase chain reaction(PCR)was used to detect the toxin genes.All toxigenic C.difficile isolates were sequenced by whole genomic sequencing(WGS)for molecular epidemiological analysis.Results From 500 diarrhea samples,49 strains ofC.difficilewere isolated,of which 40 were toxin-gene positive strains,resulting in a CDI positivity rate of 8.00%.Isolates with tcdA-positive and tcdB-positive(A+B+CDT-)were the predominant toxinotyping,accounting for 97.50%(39 out of 40),while one strain carried binary toxin genes(A+B+CDT+).The department with the highest CDI positivity rate was gastroenterology,followed by the intensive care unit(ICU).In multilocus sequence typing(MLST),there were 13 different sequence types(ST),among which ST2 was the dominant type,accounting for 30.00%.Combining WGS data analysis,there was no evidence of an epidemic or spread of C.difficile strains during the study period.Conclusion The incidence of CDI among hospitalized patients with diarrhea in our hospital was relatively low,and there was no occurrence of nosocomial transmission or outbreak.However,the possibility of an unknown source of infection cannot be ruled out,and attention should be focused on the occurrence of CDI in key departments,such as ICU patients.

关 键 词：住院患者 腹泻 艰难梭菌 毒素基因 分子分型 

分 类 号：R9[医药卫生—药学]