艰难梭菌感染患者粪便钙卫蛋白水平、疾病严重程度与高毒力核糖体分型027菌株之间的相关性
Correlation between fecal calprotectin levels, disease severity and the hypervirulent ribotype 027 strain in patients with Clostridium difficile infection.
作者信息
Peretz Avi, Tkhawkho Linda, Pastukh Nina, Brodsky Diana, Halevi Chen Namimi, Nitzan Orna
机构信息
Clinical Microbiology Laboratory, Baruch Padeh Medical Center, Poria, Tiberias, Israel.
Faculty of Medicine, Bar Ilan University, Galilee, Israel.
出版信息
BMC Infect Dis. 2016 Jun 22;16:309. doi: 10.1186/s12879-016-1618-8.
BACKGROUND
Clostridium difficile is the most common infectious etiology of nosocomial diarrhea. Fecal calprotectin (fc) is a sensitive marker of intestinal inflammation, found to be associated with enteric bacterial infections and inflammatory bowel disease.
METHODS
We evaluated fc levels using a Chemiluminescent immunoassay method, in hospitalized patients with C. difficile infection (CDI) diagnosed by molecular stool examination and assessed correlation with virulent ribotype 027 strain infection, antibiotic susceptibility by gradient Etest strip performed on C. difficile colonies and clinical and laboratory measures of disease severity. Statistical analysis was performed for correlation of fc levels with clinical and laboratory parameters, disease severity and patient outcomes.
RESULTS
Overall 29 patients with CDI were admitted at the Poria medical center in northern Israel, during June 2014-May 2015. Resistance to metronidazole was found in 3 (10.3 %) isolates and to vancomycin in 5 (17.2 %) isolates. Regarding patient outcomes, within 30 days of CDI diagnosis, recurrence of disease occurred in 10 (34.5 %) patients and 2 patients (6.9 %) died. Seven (24.1 %) isolates were C. difficile ribotype 027. Mean fc level was 331.4 μg/g (21-932). Higher fc levels were found in patients with C. difficile ribotype 027 (p < 0.0005). Fc levels were also correlated with elevated peripheral blood white cell count (p = 0.0007). A trend for higher fc levels was found in patients with a higher clostridium severity score index (p = 0.0633). No correlation was found between fecal calprotectin levels and age, sex, functional status, community versus hospital acquired CDI, antibiotic susceptibility, fever, and creatinine levels.
CONCLUSIONS
Our study highlights the fact that fc has a potential role as a biomarker of disease severity and binary toxin producing ribotype associated disease.
背景
艰难梭菌是医院获得性腹泻最常见的感染病因。粪便钙卫蛋白（fc）是肠道炎症的敏感标志物，被发现与肠道细菌感染及炎症性肠病相关。
方法
我们采用化学发光免疫分析法评估住院患者的fc水平，这些患者经分子粪便检查确诊为艰难梭菌感染（CDI），并评估其与强毒力核糖体分型027菌株感染、通过对艰难梭菌菌落进行梯度Etest试纸条检测的抗生素敏感性以及疾病严重程度的临床和实验室指标之间的相关性。对fc水平与临床和实验室参数、疾病严重程度及患者预后的相关性进行了统计分析。
结果
2014年6月至2015年5月期间，以色列北部茯苓医疗中心共收治了29例CDI患者。3株（10.3%）分离株对甲硝唑耐药，5株（17.2%）分离株对万古霉素耐药。关于患者预后，在CDI诊断后的30天内，10例（34.5%）患者疾病复发，2例（6.9%）患者死亡。7株（24.1%）分离株为艰难梭菌核糖体分型027。fc平均水平为331.4μg/g（21 - 932）。核糖体分型027的艰难梭菌患者中fc水平更高（p < 0.0005）。fc水平还与外周血白细胞计数升高相关（p = 0.0007）。在艰难梭菌严重程度评分指数较高的患者中发现fc水平有升高趋势（p = 0.0633）。未发现粪便钙卫蛋白水平与年龄、性别、功能状态、社区获得性与医院获得性CDI、抗生素敏感性、发热及肌酐水平之间存在相关性。
结论
我们的研究突出了这样一个事实，即fc作为疾病严重程度及产生二元毒素的核糖体分型相关疾病的生物标志物具有潜在作用。
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