住院腹泻患者艰难梭菌检测与分析

Detection and analysis of Clostridium difficile in hospitalized patients with diarrhea

摘要:

目的通过对住院腹泻患者粪便标本中的艰难梭菌进行筛查和不同时期检出率的比较，了解某院腹泻患者艰难梭菌的感染情况。方法收集该院2009年2—12月和2011年4—7月住院腹泻患者粪便标本106份，进行厌氧培养和API鉴定，对培养鉴定获得的菌株应用聚合酶链反应（PCR）扩增法进行A、B毒素及二元毒素基因检测；酶联荧光免疫法检测毒素A/B。结果106份标本中，厌氧培养艰难梭菌阳性16株（15.09%）。16株菌经PCR扩增，A、B毒素均阳性，二元毒素均阴性。直接毒素A/B检测阳性率为12.26%（13/106），与厌氧培养阳性率比较，差异无统计学意义（χ2=0.16，P＞0.05）。2009年2—12月和2011年4—7月两个时期的标本厌氧培养艰难梭菌阳性率分别为22.81%（13/57）、6.12%（3/49），两者比较，差异有统计学意义（χ2=5.73，P＜0.05）；毒素A/B检出率分别为17.54%（10/57）、6.12%（3/49），差异无统计学意义（χ2=3.18，P＞0.05）。艰难梭菌检测阳性患者住院期间均使用过头孢类、喹诺酮类、碳青霉烯类、广谱青霉素、克林霉素等其中一种或多种抗菌药物。结论该院艰难梭菌相关性腹泻比较严重，抗菌药物的使用是诱使艰难梭菌感染的重要因素。

Abstract:

ObjectiveTo investigate Clostridium difficile (C. difficile) infection in hospitalized patients with diarrhea by screening C.difficile in stool specimens and comparing detection rate in different periods.Methods106 stool specimens of inpatients with diarrhea between FebruaryDecember 2009 and AprilJuly 2011 were collected, anaerobic culture and API identification were performed, C.difficile isolates were detected toxin A,toxin B and binary toxin gene by polymerase chain reaction(PCR);enzymelinked fluorescence immunoassay was used for toxin A/B detection.ResultsOf 106 specimens, 16(15.09%) were positive for C.difficile. PCR amplification of toxin A/B were both positive, binary toxin was negative. The positive rate was 12.26% (13/106)by direct detection of toxin A/B,there was no significant difference compared with positive rate of anaerobic culture(χ2=0.16,P>0.05).Positive rate of anaerobic culture was 22.81%（13/57）in February December 2009 and 6.12%（3/49）in AprilJuly 2011, the difference was statistically significant (χ2=5.73,P<0.05);the detection rate of toxin A and B was 17.54%(10/57) and 6.12%(3/49) respectively, there was no significant difference(χ2=3.18,P>0.05). Patients with C. difficile infection used one or more antimicrobial agents,such as cephalosporins, quinolones, carbapenems, broadspectrum penicillin and clindamycin during hospitalization period.ConclusionC. diffilileassociated diarrhea is serious in this hospital, antimicrobial use is an important factor for inducing C.difficile infection.