Department of Medical Microbiology, Medical University of Warsaw, 5 Chałubiński Street, 02-004 Warsaw, Poland.
Department of Diagnostic Laboratory, Clinical Hospital of the Transfiguration, Poznań, Poland.
Anaerobe. 2014 Aug;28:13-7. doi: 10.1016/j.anaerobe.2014.04.007. Epub 2014 May 2.
Since 2003, a rising incidence of Clostridium difficile infection (CDI) in North America and Europe has coincided with outbreaks of C. difficile PCR ribotype 027. This ribotype was not observed in Poland until 2008. In the period 2008-2010, outbreaks of antibiotic-associated diarrhoea occurred in three different hospitals in Poland. Of 30 C. difficile isolates available for microbiological characterisation, 17 (56%) were positive for binary toxin genes and belonged to PCR ribotype 027 (n = 7) and its closely related PCR ribotype 176 (n = 10). All 17 binary toxin-positive C. difficile strains demonstrated high-level resistance to fluoroquinolones (minimum inhibitory concentration (MIC) ≥ 32 mg/L), including ciprofloxacin, gatifloxacin, and moxifloxacin, as well as erythromycin and clindamycin (MIC ≥ 256 mg/L for both). Of 14 patients from whom clinical information was available, 50% had a severe form of CDI, defined by fever (>38.5 °C), decreased kidney function, and high leucocyte count. We conclude that outbreaks of CDI associated with hypervirulent strains belonging to PCR ribotypes 027 and 176 occurred in hospitals in Poland. Further studies evaluating the clinical impact of type 176 are urgently needed.
自 2003 年以来，北美和欧洲艰难梭菌感染（CDI）的发病率上升，同时出现了 PCR 核糖型 027 的艰难梭菌爆发。这种核糖型直到 2008 年才在波兰观察到。在 2008 年至 2010 年期间，波兰的三家不同医院发生了与抗生素相关的腹泻爆发。在可用于微生物学特征分析的 30 株艰难梭菌分离株中，17 株（56%）为二元毒素基因阳性，属于 PCR 核糖型 027（n=7）及其密切相关的 PCR 核糖型 176（n=10）。所有 17 株二元毒素阳性艰难梭菌菌株均表现出对氟喹诺酮类药物（最低抑菌浓度（MIC）≥32mg/L）的高水平耐药性，包括环丙沙星、加替沙星和莫西沙星，以及红霉素和克林霉素（两者的 MIC≥256mg/L）。在可获得临床信息的 14 名患者中，50%的患者患有严重的 CDI，定义为发热（>38.5°C）、肾功能下降和白细胞计数高。我们得出结论，在波兰的医院中发生了与属于 PCR 核糖型 027 和 176 的高毒力菌株相关的 CDI 爆发。迫切需要进一步研究评估 176 型的临床影响。
