Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, P.R. China.
Key Laboratory of Enteric Pathogenic Microbiology of Ministry of Health, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, P.R. China.
Sci Rep. 2016 Nov 29;6:37865. doi: 10.1038/srep37865.
It has been widely reported that the incidence and severity of Clostridium difficile infection (CDI) have increased dramatically in North America and Europe. However, little is known about CDI in Mainland China. In this study, we aimed to investigate the incidence of CDI and the main epidemic and drug-resistant strains of C. difficile in Mainland China through meta-analysis of related studies published after the year 2010. A total of 51 eligible studies were included. The pooled incidence of toxigenic C. difficile among patients with diarrhoea was 14% (95% CI = 12-16%). In Mainland China, ST-37 and ST-3 were the most prevalent strains; fortunately, hypervirulent strains, such as ST-1 (BI/NAP1/027) and ST-11 (RT 078), have only occurred sporadically to date. The rates of C. difficile resistance to ciprofloxacin (98.3%; 95% CI = 96.9-99.7%), clindamycin (81.7%; 95% CI = 76.1-87.3%) and erythromycin (80.2%; 95% CI = 73.5-86.9%) are higher than in other counties; however, none of the C. difficile isolates reported in Mainland China were resistant to metronidazole (n/N = 0/960), vancomycin (n/N = 0/960), tigecycline (n/N = 0/41) or piperacillin/tazobactam(n/N = 0/288).
据广泛报道，艰难梭菌感染（CDI）的发病率和严重程度在北美和欧洲急剧上升。然而，关于中国大陆的 CDI 知之甚少。在这项研究中，我们通过对 2010 年后发表的相关研究进行荟萃分析，旨在调查中国大陆 CDI 的发病率以及艰难梭菌的主要流行株和耐药株。共有 51 项符合条件的研究纳入。腹泻患者产毒艰难梭菌的总发生率为 14%（95%置信区间= 12-16%）。在中国，ST-37 和 ST-3 是最常见的菌株；幸运的是，高毒力菌株，如 ST-1（BI/NAP1/027）和 ST-11（RT 078），迄今为止仅零星出现。艰难梭菌对环丙沙星（98.3%；95%置信区间= 96.9-99.7%）、克林霉素（81.7%；95%置信区间= 76.1-87.3%）和红霉素（80.2%；95%置信区间= 73.5-86.9%）的耐药率高于其他国家；然而，中国大陆报告的艰难梭菌分离株均对甲硝唑（n/N=0/960）、万古霉素（n/N=0/960）、替加环素（n/N=0/41）或哌拉西林/他唑巴坦（n/N=0/288）耐药。
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