Aptekorz Małgorzata, Szczegielniak Anna, Wiechuła Barbara, Harmanus Celine, Kuijper Ed, Martirosian Gayane
Department of Medical Microbiology, School of Medicine in Katowice, Medical University of Silesia, Poland.
Department of Microbiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
Anaerobe. 2017 Jun;45:106-113. doi: 10.1016/j.anaerobe.2017.02.002. Epub 2017 Feb 12.
Clostridium difficile is an important healthcare-associated pathogen, responsible for a broad spectrum of diarrheal diseases. The aim of this prospective study was to determine the occurrence of C. difficile infection (CDI), to characterize cultured C. difficile strains and to investigate the association of fecal lactoferrin with CDI. Between January 2013 and June 2014, 148 stool samples were obtained from adult diarrheal patients (C. difficile as a suspected pathogen) hospitalized in different healthcare facilities of 15 Silesian hospitals. Out of 134 isolated C. difficile strains, 108 were ribotyped: 82.4% belonged to Type 027, 2.8% to Type 176, 2.8% to Type 014, 1.9% to Type 010 and 0.9% to Types 001, 018, 020 and 046 each. In total, 6.5% non-typable strains were identified. All Type 027 isolates contained both toxin genes tcdA & tcdB, and binary toxin genes (cdtA &cdtB). Susceptibility testing revealed that all Type 027 isolates were sensitive to metronidazole and vancomycin and resistant to moxifloxacin, ciprofloxacin, imipenem and erythromycin. Of 89 Type 027 strains, 16 had a ermB (688 bp) gene coinciding with high levels of erythromycin resistance (MIC >256 μg/mL). Of 16 ermB positive strains, 14 demonstrated also high level of resistance to clindamycin (>256 μg/mL). A significant difference (p = 0.004) in lactoferrin level was found between C. difficile toxin-positive (n = 123; median 185.9 μg/mL; IQR 238.8) and toxin-negative (n = 25; median 22.4 μg/mL; IQR 141.7) fecal samples. Stool samples from n = 89 patients with CDI caused by Type 027 demonstrated significantly higher (p = 0.03) lactoferrin level (median 173.0 μg/mL; IQR 237.3) than from patients with CDI caused by other ribotypes and non-typable C. difficile strains (median 189.4 μg/mL; IQR 190.8).
艰难梭菌是一种重要的医疗保健相关病原体，可引发多种腹泻疾病。这项前瞻性研究的目的是确定艰难梭菌感染（CDI）的发生率，对培养的艰难梭菌菌株进行特征分析，并研究粪便乳铁蛋白与CDI之间的关联。在2013年1月至2014年6月期间，从西里西亚15家医院不同医疗保健机构住院的成年腹泻患者（疑似病原体为艰难梭菌）中采集了148份粪便样本。在134株分离出的艰难梭菌菌株中，对108株进行了核糖分型：82.4%属于027型，2.8%属于176型，2.8%属于014型，1.9%属于010型，0.9%分别属于001、018、020和046型。总共鉴定出6.5%的不可分型菌株。所有027型分离株均同时含有毒素基因tcdA和tcdB以及二元毒素基因（cdtA和cdtB）。药敏试验显示，所有027型分离株对甲硝唑和万古霉素敏感，对莫西沙星、环丙沙星、亚胺培南和红霉素耐药。在89株027型菌株中，16株具有ermB（688 bp）基因，与高水平的红霉素耐药性（MIC>256μg/mL）一致。在16株ermB阳性菌株中，14株对克林霉素也表现出高水平耐药（>256μg/mL）。在艰难梭菌毒素阳性（n = 123；中位数185.9μg/mL；IQR 238.8）和毒素阴性（n = 25；中位数22.4μg/mL；IQR 141.7）的粪便样本中，乳铁蛋白水平存在显著差异（p = 0.004）。由027型引起的89例CDI患者的粪便样本显示，乳铁蛋白水平（中位数173.0μg/mL；IQR 237.3）显著高于由其他核糖型和不可分型艰难梭菌菌株引起的CDI患者（中位数189.4μg/mL；IQR 190.8）（p = 0.03）。
