摘要
为了解上海地区住院人类免疫缺陷病毒(HIV)感染患者中艰难梭菌相关性腹泻(CDAD)的发生率、临床特征、药敏及分型情况,收集250例住院HIV感染腹泻患者的粪便,用选择性培养基进行艰难梭菌和一般肠道致病菌分离;用E-Test法测定艰难梭菌对甲硝唑、万古霉素、克林霉素、莫西沙星的敏感度;用多位点序列分型法(MLST)和聚合酶链反应(PCR)检测菌株基因类型及细菌毒素基因tcdA和tcdB。结果共检出29株(11.6%)艰难梭菌,均对甲硝唑、万古霉素敏感,对莫西沙星和克林霉素的耐药率分别为31.0%和69.0%。MLST分型共检出12种ST型别(ST-2、-3、-7、-8、-26、-35、-37、-38、-39、-54、-81和-124),其中ST-54(6/29,20.7%)和ST-39(5/29,17.2%)是主要流行亚型;毒素基因tcdA+/tcdB+17株(17/29,58.6%),毒素基因tcdA-/tcdB-12株(12/29,41.4%),未检出毒素基因tcdA-/tcdB+菌株。结果提示,上海地区住院HIV感染腹泻患者粪便标本中艰难梭菌的分离率较高,需严密监控以防暴发流行。
To investigate Clostridium-difficile （C. difficile ）-associated diarrhea （CDAD） in human immunodeficiency virus （HIV）-infected inpatients in Shanghai, C. difficile and general intestinal tract pathogenic bacteria were isolated by selective medium from abnormal fecal specimens collected from 250 HIV-infected inpatients from March 2012 to March 2013. The susceptibilities of C. difficile to metronidazole, vancomycin, clindamycin and moxifloxacin were determined by E-test method. Molecular typing was performed by multi-locus sequence typing （MLST）. The genes tcdA and tcdB of toxins A and B were detected by conventional polymerase chain reaction （PCR）. 29 clinical strains of C. difficile were isolated from 250 fecal specimens （11.6%）, in which 17 strains were tedA＋/tcdB＋ and 12 strains were tcdA- /tcdB -. All strains were susceptible to metronidazole and vancomycin. Resistance to clindamycin and moxifloxacin was found in 69.0% and 31.0% strains respectively. A total of 12 different sequence types （ST-2, -3, -7, -8, -26, -35, -37, -38, -39, -54, -81, and -124） were identified. The most prevalent ST types were ST-54 （6/29, 20.7%） and ST-39 （5/29, 17.2%）. The results suggest that the rate of positive C. difficile detection is high and should be monitored strictly to prevent outbreak.
出处
《微生物与感染》
2015年第5期282-287,共6页
Journal of Microbes and Infections
基金
复旦大学感染性疾病实验诊断(复医科办字[2012]1号)
关键词
人类免疫缺陷病毒
艰难梭菌相关性腹泻
毒素
药敏试验
多位点序列分型
Human immunodeficiency virus
Clostridium difficile-associated diarrhea
Toxin
Drugsusceptibility testing
Multi-locus sequence typing
