Putsathit P, Maneerattanaporn M, Piewngam P, Kiratisin P, Riley T V
Microbiology and Immunology, School of Pathology and Laboratory Medicine, The University of Western Australia, Crawley, Western Australia, Australia.
Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
New Microbes New Infect. 2016 Oct 21;15:27-32. doi: 10.1016/j.nmni.2016.10.004. eCollection 2017 Jan.
Little is known about infection (CDI) in Asia generally, and specifically in Thailand. Given the high prevalence of inappropriate antibiotic usage in this region, CDI is likely to be common. This study investigated the prevalence and molecular epidemiology of CDI in Thailand. Stool specimens collected from inpatients with diarrhoea at Siriraj hospital in Bangkok ( 422) were cultured on ChromID Cdiff agar and any presumptive colonies were identified, PCR ribotyped and toxin profiled. As part of the routine testing at Siriraj Hospital, 370 specimens also underwent testing with the BD MAX Cdiff assay to detect the presence of With direct culture, 105 different isolates of were recovered from 23.7% (100/422) of the stool specimens. The prevalence of toxigenic and nontoxigenic isolates was 9.2% (39/422) and 15.6% (66/422), respectively. Of the toxigenic isolates, 69.2% (27/39) and 30.8% (12/39) were and positive (AB), and AB, respectively; none contained binary toxin genes. The five most prevalent ribotypes (RTs) were 014/020 group (17/105), 010 (12/105), 017 (12/105), 039 (9/105) and 009 (6/105). Using toxigenic culture as the reference standard, the sensitivity, specificity, positive predictive value and negative predictive value of the BD MAX Cdiff assay were 68.6, 95.1, 63.2 and 96.1%, respectively. The high proportion of AB, RT 017 strains emphasises the need for diagnostic tests that detect either both toxins or just Continued surveillance that involves stool culturing will allow molecular tracking and assist in elucidating the epidemiology of CDI in Thailand.
总体而言，亚洲地区对艰难梭菌感染（CDI）的了解甚少，泰国的情况尤其如此。鉴于该地区抗生素使用不当的情况普遍，CDI可能很常见。本研究调查了泰国CDI的患病率及分子流行病学情况。从曼谷诗里拉吉医院腹泻住院患者中采集的粪便标本（共422份）在ChromID Cdiff琼脂上培养，对任何疑似菌落进行鉴定、PCR核糖体分型和毒素分析。作为诗里拉吉医院常规检测的一部分，370份标本还采用BD MAX Cdiff检测法进行检测以确定是否存在[未提及具体检测物]。通过直接培养，从23.7%（100/422）的粪便标本中分离出105种不同的艰难梭菌菌株。产毒菌株和非产毒菌株的患病率分别为9.2%（39/422）和15.6%（66/422）。在产毒菌株中，69.2%（27/39）仅毒素A（tcdA）阳性、30.8%（12/39）毒素A和毒素B（tcdB）均阳性（AB型）；均不含有二元毒素基因。五种最常见的核糖体分型（RTs）为014/020组（17/105）、010型（12/105）、017型（12/105）、039型（9/105）和009型（6/105）。以产毒培养作为参考标准，BD MAX Cdiff检测法的敏感性、特异性、阳性预测值和阴性预测值分别为68.6%、95.1%、63.2%和96.1%。毒素A和毒素B均阳性的017型核糖体分型菌株比例较高，这凸显了需要能够检测两种毒素或仅检测毒素A的诊断检测方法。持续进行粪便培养监测将有助于分子追踪，并协助阐明泰国CDI的流行病学情况。
