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The Clostridium difficile infection conditions and molecular epidemic characteristics of clinical diarrhea patients |
FENG Xuejun1 XU Shaoyi2 WU Xiaoyan1 |
1.Department of Clinical Laboratory, the Second Hospital of Jiaxing City, Zhejiang Province, Jiaxing 314000, China;
2.Intensive-Care Unit, the Second Hospital of Jiaxing City, Zhejiang Province, Jiaxing 314000, China |
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Abstract Objective To understand the infection conditions and molecular epidemic characteristics of Clostridium difficile in clinical patients with diarrhea, to provide a basis for controlling nosocomial infections and clinical diagnosis and treatment. Methods Eight hundred and fifty-two feces samples from clinical diarrhea patients in the Second Hospital of Jiaxing City from January to December 2016 were collected as experimental group and 310 feces samples from healthy examination adults in the same period were collected as control group. The positive rate of Clostridium difficile was obtained by anaerobic culture and taken comprehensive analysis by combining with toxin genotype and multilocus sequence typing. Results A total of 108 Clostridium difficile were isolated from 852 feces samples of experiment group, with a positive rate of 12.68%, while a total of 8 Clostridium difficile were isolated from 310 feces samples of control group, with a positive rate of 2.58%, the difference between the two groups was statistically significant (P < 0.05). The experiment group was dominated by tcdA+tcdB+ strains, accounted for 86.11% (93/108), tcdA-tcdB+ strains accounted for 5.56% (6/108), and tcdA-tcdB-strains accounted for 8.33% (9/108), the rate of toxin production was 91.67%, while the corresponding toxin genotypes of the control group accounted for 62.50% (5/8), 12.50% (1/8), 25.00% (2/8), and the rate of toxin production was 75.00%, the rate of toxin production between the two groups had no statistically significant difference (P > 0.05). In the experiment group, 32 ST types were found by multisite sequence typing, among which, ST54 was a relatively popular type, while CC48 was a relatively popular clonal complex. Conclusion The infection rate of Clostridium difficile in clinical patients with diarrhea is high, which is urgent to attract clinical attention and strengthen the prevention and control of the hospital infection, to prevent epidemic outbreak.
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[1] Roshan N,Riley TV,Hammer KA. Effects of natural products on several stages of the spore cycle of Clostridium difficile in vitro [J]. J Appl Microbiol,2018. doi:10.1111/jam.13889.
[2] 倪晓平,徐虹,金慧,等.两种消毒产品杀灭艰难梭菌芽孢试验与评价[J].中华医院感染学杂志,2016,26(11):2425-2427.
[3] Alyousef AA. Clostridium difficile:Epidemiology,Pathogenicity,and an Update on Limitations of and Challenges in Its Diagnosis [J]. J AOAC Int,2018,101(4):1119-1126.
[4] Bagdasarian N,Rao K,Malani PN. Diagnosis and treatment of Clostridium difficile in adults:a systematic review [J]. JAMA,2015,313(4):398-408.
[5] 中国医师协会检验医师分会感染性疾病检验医学专家委员会.中国成人艰难梭菌感染诊断和治疗专家共识[J].协和医学杂志,2017,8(2/3):131-138.
[6] Song Y,Garg S,Girotra M,et al. Microbiota dynamics in patients treated with fecal microbiota transplantation for recurrent Clostridium difficile infection [J]. PLoS One,2014,9(7):e104471.
[7] Kwon JH,Olsen MA,Dubberke ER. The morbidity,mortality,and costs associated with Clostridium difficile infection [J]. Infect Dis Clin North Am,2015,29(1):123-124.
[8] Persson S,Torpdahl M,Olsen KE. New multiplex PCR method for the detection of Clostridium difficile toxin A(tcdA)and toxin B(tcd B) and the binary toxin (cdtA/cdtB) genes applied to a Danish strain collection [J]. Clin Microbiol Infect,2008,14(11):1057-1064.
[9] Griffiths D,Fawley W,Kachrimanidou M,et al. Multilocus sequence typing of Clostridium difficile [J]. J Clin Microbiol,2010,48(3):770-778.
[10] McDonald LC,Gerding DN,Johnson S,et al. Clinical Practice Guidelines for Clostridium difficile infection in Adults and Children:2017 Update by the Infectious Diseases Society of America(IDSA) and Society for Healthcare Epidemiology of America(SHEA)[J]. Clin Infecs Dis,2018,66(7):e1-e48.
[11] McLure A,Clements ACA,Kirk M,et al. Clostridium difficile classification overestimates hospital-acquired infections [J]. J Hosp Infect,2018,99(4):453-460.
[12] 徐凯悦.2010~2015年临床分离艰难梭菌产毒株的分子流行病学、耐药状况以及对利福霉素耐药机制研究[D].石家庄:河北医科大学,2016年.
[13] 谢和宾,曾鸿,尹柯,等.我国住院腹泻患者艰难梭菌感染率的荟萃分析[J].中华医院感染学杂志,2017,27(5):961-964.
[14] 贾天野,汤一韦,曲芬.美国艰难梭菌感染临床诊治相关指南摘要[J].传染病信息,2015,28(4):193-196.
[15] Hopkins RJ,Wilson RB. Treatment of recurrent Clostridium difficile colitis:a narrative review [J]. Gastroenterol Rep(Oxf),2018,6(1):21-28.
[16] Di Bella S,Ascenzi P,Siarakas S,et al. Clostridium difficile Toxins A and B:Insights into Pathogenic Properties and Extraintestinal Effects [J]. Toxins(Basel),2016,8(5):134.
[17] Chen YB,Gu SL,Wei ZQ,et al. Molecular epidemiology of Clostridium difficile in a tertiary hospital of china [J]. J Med Microbiol,2014,63(Pt 4):562-569.
[18] Wang R,Suo L,Chen HX,et al. Molecular epidemiology and antimicrobial susceptibility of Clostridium difficile isolated from the Chinese People′s Liberation Army General Hospital in China [J]. Int J Infect Dis,2017,67:86-91.
[19] Jin D,Luo Y,Huang C,et al. Molecular Epidemiology of Clostridium difficile Infection in hospitalized Patients in Eastern China [J]. J Clin Microbiol,2017,55(3):801-810.
[20] 陈丽丹.不同来源的艰难梭菌其毒素、MLST分型及药敏情况的分析[D].广州:南方医科大学,2016.
[21] Wang P,Zhou Y,Wang Z,et al. Identification of Clostridium difficile ribotype 027 for the first time in Mainland China [J]. Infect Control Hosp Epidemiol,2014,35(1):95-98.
[22] Cheng JW,Xiao M,Kudinha T,et al. The first two Clostridium difficile ribotype 027/ST1 isolates identified in Beijing,China-an emerging problem or a neglected threat?[J].Sci Rep,2016,6:18834. |
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