Clinical and microbiological characterization of Clostridium difficile infection in a tertiary care hospital in Shanghai, China
Clinical and microbiological characterization of Clostridium difficile infection in a tertiary care hospital in Shanghai, China
复制标题
中国上海一家三级医院艰难梭菌感染的临床和微生物学特征
DOI：
10.3760/cma.j.issn.0366-6999.20132724
复制
发表时间：
2014-05-05
影响因子：
6.1
通讯作者：
Mao Enqiang
中科院分区：
文献类型：
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作者：
Dong Danfeng;Peng Yibing;Mao Enqiang
背景在过去的十年中，艰难梭菌感染（CDI）已成为一种重要的医院感染，但在中国报道很少。本研究旨在描述上海某医院CDI的临床和微生物学特征。方法回顾性分析我院2010年12月至2013年3月收治的CDI患者的临床资料。分析相应分离株的微生物学特征，包括多位点序列分型（MLST）基因型、抗菌药物敏感性、毒素产生、孢子形成能力、生物膜形成和运动性。结果本研究期间共纳入94例CDI病例，其中12例为重症病例。通过回顾临床资料，所有患者均经验性地使用质子泵抑制剂或抗生素或两者并用，且分布广泛，最常见的是消化科病房（28/94，29.79%）。重症病例与轻型病例相比，在基本流行病学资料和微生物学特征方面均无显著差异。在94株分离株中，31株为毒素A阴性毒素B阳性，基因分型均为ST 37。它们产生的毒素和孢子较少，生物膜和运动百分比相似，但对头孢菌素类、喹诺酮类、大环内酯-林可酰胺和链阳性菌素（MLSB）和四环素的耐药性最高。结论重症病例中未发现特异性临床基因型或微生物学特征，耐药性可能是导致CDI传播和持续存在的主要原因。
Background Over the last decade, Clostridium difficile infection (CDI) has emerged as a significant nosocomial infection, yet little has been reported from China. This study aimed to characterize the clinical and microbiological features of CDI from a hospital in Shanghai. Methods Patients with CDI seen between December 2010 and March 2013 were included in this study, of which clinical data were retrospectively collected. The microbiological features of corresponding isolates were analyzed including genotype by multi‐locus sequence typing (MLST), antimicrobial susceptibility, toxin production, sporulation capacity, biofilm formation, and motility. Results Ninety‐four cases of CDI were included during this study period, 12 of whom were severe cases. By reviewing the clinical data, all patients were treated empirically with proton pump inhibitor or antibiotics or both, and they were distributed widely across various wards, most frequently to the digestive ward (28/94, 29.79%). Comparing the severe with mild cases, no significant differences were found in the basic epidemiological data or the microbiological features. Among the 94 isolates, 31 were toxin A‐negative toxin B‐positive all genotyped as ST37. They generated fewer toxins and spores, as well as similar amounts of biofilm and motility percentages, but exhibited highest drug resistance to cephalosporins, quinolones, macrolide‐lincosamide and streptogramin (MLSB), and tetracycline. Conclusions No specific clinical genotype or microbiological features were found in severe cases; antimicrobial resistance could be the primary reason for epidemic strains leading to the dissemination and persistence of CDI.