摘要
目的利用快速核酸多重检测平台检测宁波地区腹泻患者艰难梭菌(CD)的感染率及致病性(毒素A、B和二元毒素AB的携带状况),探究社区获得性艰难梭菌感染(CA-CDI)的相关因素。方法收集2016年6-12月因腹泻就诊于宁波11家社区卫生院的门诊患者680例为研究对象。通过厌氧培养法、核酸多重检测平台快速检测法检测艰难梭菌,并对分离到的菌株进行毒素基因检测和4种抗菌药物药敏检测。同时收集患者临床资料,归纳CA-CDI的相关因素。结果共收集646份有效腹泻标本,分离获得CD共42例(6.50%);近4周接受抗感染治疗、近8周接受化疗、4周内使用抑酸药物(PPI)是CA-CDI的相关因素。本地区社区获得性CD普遍携带两种毒素基因,41株为tcdA+/tcdB+/cdtA-,仅有1株为tcdA-/tcdB+/cdtA-。同时发现1株可能引起严重肠道病变的tcdA+/tcdB+/cdtA+的高产毒株。MOKOBIO系统对菌体直接检测法其敏感性为95.24%,特异性100.00%。所有菌株对甲硝唑和万古霉素均呈高度敏感。分离菌株对克林霉素敏感率为11.90%,对红霉素敏感占45.24%;且有45.24%对克林霉素高度耐药(MIC>128mg/L)、54.76%的菌株对红霉素呈高度耐药(MIC>128mg/L)。结论快速核酸多重检测平台(MOKOBIO)直接检测粪便样本敏感性、特异性良好,可提高艰难梭菌感染的诊断率,方便在基层医疗单位广泛应用。
OBJECTIVE To detect the infection rate of Clostridium difficile（CD）and pathogenicity（toxin A,toxin B,and binary toxin AB）in patients with diarrhea in nucleic acid multiplex detection platform,and explore risk factors of community-acquired CD infection.METHODS A total of 680 outpatients who were diagnosed with diarrhea in 11 community health centers in Ningbo between Jun.2016 and Dec.2016 were collected.Both aerobic culture and rapid multiplex molecular method were performed in detection of CD.Toxic genes were detected in all clinical isolates and antimicrobial susceptibility tests were performed at the same period.All clinical data were collected and independent risk factors of CA-CDI were concluded.RESULTS A total of 42（6.50%）strains of CD were isolated from 646 fecal samples.The anti-infection treatment in nearly 4 weeks,chemotherapy in nearly 8 weeks and the use of PPI within 4 weeks were risk factors of CA-CDI.The resules showed that community-acquired CDs in the region generally carried two toxin genes.The dominant genotype of CD strains was tcdA＋/tcdB＋/cdtA-（41 strains）,only 1 stain was identified as tcdA-/tcdB＋/cdtA-,and 1 potentially high virulent tcdA＋/tcdB＋/cdtA＋ strain which could cause severe intestinal lesions was found.Comparing the rapid multiplex molecular plat（MOKOBI）with culture-based method in detecting CD the sensitivity was 95.24% and the specificity was 100%.All CD strains were susceptible to metronidazole and vancomycin.The drug susceptiblity reates of the isolated strains to clindamycin and erythromycin were 11.90% and 45.24%,respectively.High proportions of isolates showed high-level（MIC〉128 mg/L）of resistant rates to clindamycin（45.24%）and erythromycin（54.76%）.CONCLUSION Application of rapid multiplex molecular plat（MOKOBI）is superior in term of sensitivity and specificity for the direct detection of fecal samples,it can improve the diagnostic rate of CD infection,which is convenient to be widely used in community health care facilities.
作者
张卉卉
俞万钧
马坚
汪一萍
鲁勇
金大志
陈晓飞
姜昊
ZHANG Hui-hui;YU Wan-jun;MA Jian;WANG Yi-ping;LU Yong;JIN Da-zhi;CHEN Xiao-fei;JIANG Hao(Yinzhou Hospital Affiliated To Medical School of Ningbo University, Ningbo , Zhejiang 315040, China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2018年第11期1621-1624,1649,共5页
Chinese Journal of Nosocomiology
基金
浙江省医药卫生科技计划基金资助项目(2017190084)
宁波市自然科学基金资助项目(2015A610310
2016A610021)
关键词
艰难梭菌感染
社区获得性
分子诊断
相关因素
流行病学
Clostridium difficile infection
Community-associated
Molecular diagnosis
Risk fact
Epidemiology
