艰难梭菌相关性腹泻患者50例临床特征及其病原菌耐药性分析

目的研究艰难梭菌相关性腹泻（CDAD）患者的临床特征及艰难梭菌的毒素基因和抗菌药物耐药性情况。方法对163例医院感染性腹泻患者采用选择性培养基培养艰难梭菌，用常规PCR法分别检测艰难梭菌毒素A、B的基因tcdA和tcdB，并根据检测结果分为CDAD组和非CDAD组，记录两组患者的临床特征；同时采用E—test法检测其中的产毒艰难梭菌对甲硝唑、万古霉素、利福平、克林霉素和莫西沙星的敏感性。结果在163份临床标本中共培养得到50株（30.7％）产毒艰难梭菌；两组在发热、水样便发生率和血清白蛋白水平方面的差异均有统计学意义（均P〈0.05）。A^＋B^＋为33株（66O％），A^-B^＋为17株（34．0％）；产毒株对甲硝唑、万古霉素、利福平、克林霉素和莫西沙星的耐药率分别为0％、0％、18％、68％和48％。结论艰难梭菌A^-B^＋菌株有较高的分离率，50株艰难梭菌均对甲硝唑和万古霉素敏感，但对克林霉素和莫西沙星耐药率较高。

Clinical characteristics and antimicrobial susceptibility of clostridium difficile associated diarrhea

Objective To investigate the clinical characterizations and resistance to antibiotics of clostridium difficile associated diarrhea. Methods Clostridium difficile straits were selected by cycloserine-cefoxitin-fructose agar from fecal specimens of 163 patients with diarrhea The genes tcdA and tcdB of toxin A and B were detected by conventional PCR, The antibiotic resistance of toxic clostridium difficile to metronidazole, vancomycin, rifampicin, moxifioxacin and clindamycin was examined by E-test method. Results Fifty clinical strains of toxic clostridium difficile were isolated from 163 fecal specimens （30,7%）, in which 17 strains were A^-B^＋ and 33 strains were A^＋B^＋. All strains were susceptible to metronidazole and vancomycin. Resistance to rifammpicin, moxifloxacin and ctindamycin was found in 18%, 48% and 68% of the isolates respectively. Conclusion The clinical isolates of clostridium difficile in this study are all susceptible to metronidazole and vancomycin, but have high resistant rates to moxifloxacin and ctindamycin.