Molecular epidemiology of Clostridium difficile in two tertiary care hospitals in Shandong Province, China.
Molecular epidemiology of Clostridium difficile in two tertiary care hospitals in Shandong Province, China.
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中国山东省两家三级医院艰难梭菌的分子流行病学
DOI：
10.2147/idr.s152724
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发表时间：
2018
影响因子：
3.9
通讯作者：
Kudinha T
中科院分区：
文献类型：
--
作者：
Luo Y;Zhang W;Cheng JW;Xiao M;Sun GR;Guo CJ;Liu MJ;Cong PS;Kudinha T
艰难梭菌感染（CDI）的发病率和严重程度在过去十年中显著增加。然而，到目前为止，中国关于CDI的流行病学数据非常有限，特别是山东省没有相关数据。本研究的目的是评估CDI的诊断方法，并获取中国山东省CDI的分子流行病学数据。
通过谷氨酸脱氢酶（GDH）、艰难梭菌毒素A和B（CDAB）检测以及产毒培养对504份非重复的不成形粪便标本进行了研究。此外，对85株分离菌进行了毒素基因检测、多位点序列分型、核糖分型和抗菌药物敏感性试验。
GDH和CDAB检测相结合的方法能够对54.2%的CDI病例做出诊断，并排除90%的非CDI病例。在该方法中进一步加入产毒培养可将检测灵敏度提高到100%。产毒菌株占分离菌的84.7%，包括A + B + CDT -（71.8%，61/85）、A - B + CDT -（11.8%，10/85）和A + B + CDT +（1.2%，1/85）菌株。RT046/ST35（13.9%，10/72）、RT014/ST2（12.5%，9/72）和RT017/ST37（12.5%，9/72）是产毒艰难梭菌菌株中较为常见的基因型。A - B + CDT -毒素基因基因型的临床严重程度评分（3.50±0.85）显著高于A + B + CDT -型（2.59±0.93）（P<0.05）。RT046/ST35分离菌的流行率很高，且临床严重程度评分较高（3.80±0.92）。观察到不同序列型（STs）的耐药性存在差异。与非产毒菌株相比，产毒菌株对红霉素、克林霉素和环丙沙星的耐药率更高（P<0.05）。
山东省艰难梭菌的流行病学情况与中国其他地区不同。应建立并应用综合优化的诊断策略和持续监测，以遏制产毒艰难梭菌菌株的传播，尤其是针对住院患者。
Purpose The incidence and severity of Clostridium difficile infection (CDI) have markedly increased over the past decade. However, there is very limited epidemiological data on CDI in China so far, specifically no data in Shandong Province. The aim of this study was to evaluate diagnostic algorithm for CDI and to gain data on molecular epidemiology of CDI in the Shandong Province of China. Materials and methods Nonrepetitive unformed fecal specimens (n=504) were investigated by the glutamate dehydrogenase (GDH), C. difficile toxin A&B (CDAB) tests and toxigenic culture. Furthermore, 85 isolates were characterized by toxin gene detection, multilocus sequence typing, ribotyping and antimicrobial susceptibility testing. Results The algorithm of combining GDH and CDAB tests could define diagnosis of 54.2% CDI cases and excluded 90% of non-CDI. Further adding the toxigenic culture to the algorithm enhanced the detection sensitivity to 100%. Toxigenic strains comprised 84.7% of isolates, including A+B+CDT− (71.8%, 61/85), A−B+CDT− (11.8%, 10/85) and A+B+CDT+ (1.2%, 1/85) isolates. RT046/ST35 (13.9%, 10/72), RT014/ST2 (12.5%, 9/72) and RT017/ST37 (12.5%, 9/72) were the more common genotypes among toxigenic C. difficile strains. The clinical severity score of A−B+CDT− toxin genes genotype (3.50±0.85) was significantly higher than the A+B+CDT− type (2.59±0.93) (P<0.05). RT046/ST35 isolates were highly prevalent and had high clinical severity scores (3.80±0.92). Variations in resistance from different sequence types (STs) were observed. Toxigenic strains showed higher resistance rates to erythromycin, clindamycin and ciprofloxacin compared to nontoxigenic strains (P<0.05). Conclusion The epidemiology of C. difficile in Shandong Province differed from other regions in China. Comprehensive optimized diagnosis strategy and continuous surveillance should be established and applied in order to curb the spread of toxigenic C. difficile strains, especially for hospitalized patients.