杭州市富阳区住院腹泻患者艰难梭菌感染及菌株分子特征分析

目的了解浙江省杭州市富阳地区住院腹泻患者艰难梭菌感染情况，研究感染患者临床危险因素及分离菌株的分子特征。方法收集2017年5月至2018年2月就诊于第一人民医院的228例腹泻患者的粪便标本，通过厌氧培养进行艰难梭菌菌株分离和鉴定，进行多位点序列基因分型，以琼脂稀释法测定菌株耐药性，对患者临床资料进行统计分析。结果228份标本共检测出产毒型艰难梭菌41株，其中31株为医院获得性腹泻；阳性患者平均年龄67.8岁，主要来自消化内科（34.1%）和肾内科（19.5%）。 ST2、ST3和ST54为主要基因型。 所有菌株对万古霉素、甲硝唑、四环素、哌拉西林敏感。 临床资料统计分析显示，＞60周岁、患基础性疾病和有抗生素用药史的阳性患者数量远高于阴性患者比例（χ2＝4.229、9.022、5.767，P＝0.023、0.001、0.009）。结论杭州市富阳区住院腹泻患者艰难梭菌感染患者主要来源于院内感染。 患有基础性疾病、8周内有抗生素用药史的老年患者为感染的危险因素；在院内感染防控中需进一步加强监测。

Molecular characteristics of Clostridium difficile infection in diarrhea inpatients in Fuyang district of Hangzhou,Zhejiang

ObjectiveTo investigate current infection status of Clostridium difficile in hospitalized patients with diarrhea in Fuyang district of Hangzhou, Zhejiang province. Molecular characteristics of C. difficile isolates and risk factors of the patients were analyzed.MethodsA total of 228 stool samples were collected the diarrhea patients in our hospital from May 2017 to February 2018. C. difficile strains isolation and identification were performed by using anaerobic culture. The isolates were typed by multilocus sequence typing. The antibiotic resistance test was performed by using agar dilution assay. The clinical data were statistically analyzed.ResultsForty one strains of toxigenic C. difficile were isolated from 228 stool samples, in which 31 strains of C. difficile were from patients with hospital acquired diarrhea. The average age of the patients was 67.8 years, the patients were mainly from departments of gastroenterology (34.1%) and nephrology (19.5%). ST2, ST3 and ST54 were the major sequence types. All the isolates were sensitive to metronidazole, vancomycin, tetracycline, and piperacillin. The results of clinical data analysis showed that more diarrhea patients who were aged ＞60 years, had underlying diseases and used antibiotics within 8 weeks were infected with C. difficile（χ2＝4.229, 9.022, 5.767, P＝0.023, 0.001, 0.009）.ConclusionC. difficile infection mainly occurred in hospitalized diarrhea patients in Fuyang. Old age, underlying disease and antibiotic use within 8 weeks were the risk factors for C. difficile infection. This study indicated that C. difficile surveillance needs to be further strengthened in the prevention and control of nosocomial infection.