Martirosian Gayane, Szczesny Adam, Cohen Stuart H, Silva Joseph
Department of Medical Microbiology, Medical University of Silesia, 40-572 Katowice, Poland.
Diagn Microbiol Infect Dis. 2005 Jun;52(2):153-5. doi: 10.1016/j.diagmicrobio.2004.12.015.
The frequency of Clostridium difficile strains in stool samples of patients with diarrhea hospitalized in the hematology/oncology, surgery, orthopedics, transplantology ward, and emergency room of Davis Medical Center was analyzed. A total of 786 stool samples collected from patients with diarrhea and 180 samples taken from the hospital environment were cultured for C. difficile by routine methods. There were 119 strains of C. difficile isolated: 97 (12.3%) strains from patients' stools (no enteropathogen other than C. difficile was detected in these stool samples) and 22 (12.2%) strains from the hospital environment. It was confirmed that hospital environment plays an important role in transmission of C. difficile by AP-PCR and PCR ribotyping. Among 97 C. difficile strains isolated from patient' stools 25 were nontoxigenic (A-/B-), 67 were toxigenic (A+/B+), and 5 strains were toxin B-positive/toxin A-negative. Analysis of concomitant symptoms among hospitalized patients with diarrhea demonstrated significantly longer duration of diarrhea caused by nontoxigenic strains than in cases of diarrhea caused by toxigenic strains. On the other hand, among patients infected by toxigenic strains, significantly higher leukocytosis and longer duration of fever were observed. The resistance of isolated C. difficile strains to erythromycin and clindamycin indicated the possibility of transmission in the hospital strains with macrolide-lincosamide-streptogramin B resistance type.
分析了戴维斯医疗中心血液学/肿瘤学、外科、骨科、移植病房及急诊室腹泻住院患者粪便样本中艰难梭菌菌株的频率。通过常规方法对从腹泻患者收集的786份粪便样本和从医院环境采集的180份样本进行艰难梭菌培养。共分离出119株艰难梭菌：97株（12.3%）来自患者粪便（这些粪便样本中未检测到除艰难梭菌外的其他肠道病原体），22株（12.2%）来自医院环境。通过扩增片段长度多态性聚合酶链反应（AP-PCR）和PCR核糖体分型证实医院环境在艰难梭菌传播中起重要作用。从患者粪便中分离出的97株艰难梭菌中，25株为非产毒型（A-/B-），67株为产毒型（A+/B+），5株为毒素B阳性/毒素A阴性。对腹泻住院患者伴随症状的分析表明，非产毒菌株引起的腹泻持续时间明显长于产毒菌株引起的腹泻。另一方面，在产毒菌株感染的患者中，观察到明显更高的白细胞增多症和更长的发热持续时间。分离出的艰难梭菌菌株对红霉素和克林霉素的耐药性表明医院菌株有传播大环内酯-林可酰胺-链阳菌素B耐药类型的可能性。
