Yan Dong, Chen Yunbo, Lv Tao, Huang Yandi, Yang Jiezuan, Li Yongtao, Huang Jianrong, Li Lanjuan
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China.
Department of Laboratory Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China.
J Med Microbiol. 2017 Oct;66(10):1483-1488. doi: 10.1099/jmm.0.000596. Epub 2017 Sep 25.
The aim of this study was to investigate the toxigenic Clostridium difficile colonization (CDC, colonization with toxigenic C. difficile but without symptoms) and C. difficile infection (CDI, active C. difficile infection resulting in disease symptoms) in hepatic cirrhosis patients, identify the risk factors of CDC, and determine the correlation between CDC and CDI.
The strains of toxigenic C. difficile were isolated from patients with hepatic cirrhosis within 48 h after admission, followed by multilocus sequence typing (MLST). Patients were divided into toxigenic CDC group and noncolonized (NC) group according to the colonization. Logistic regression analysis was performed to analyse the risk factors for the CDC. Besides, the CDI incidence was compared between the two groups.
Colonization of toxigenic C. difficile was identified in 104 cases (19.8 %). Eighteen sequence types (STs) were identified, among which ST-3, ST-54, ST-35 and ST-37 were the predominant types. Child-Pugh class C(relative risk, RR, 3.025; 95 % CI: 1.410-6.488), decrease of prothrombin time activity (PTA) (RR 2.180; 95 % CI: 1.368-3.476), decrease of platelet (RR 2.746; 95 % CI: 0.931-8.103) and concurrent hepatic encephalopathy (RR 1.740; 95 % CI: 1.012-2.990) were identified as the risk factors for the hepatic cirrhosis patients with CDC. The CDI incidence in the CDC group was also significantly higher than that of the NC group (26.0 % vs 1.7 %, P<0.001).
An carriage rate of 19.8 % was reported in the hepatic cirrhosis patients with C. difficile colonization. Child's class C, decrease of PTA and platelet, and concurrent hepatic encephalopathy were the risk factors for the hepatic cirrhosis patients with C. difficile colonization. Hepatic cirrhosis patients with C. difficile colonization were more susceptible to CDI.
本研究旨在调查肝硬化患者中产毒艰难梭菌定植（CDC，即定植有毒性艰难梭菌但无症状）及艰难梭菌感染（CDI，即导致疾病症状的活动性艰难梭菌感染）情况，确定CDC的危险因素，并明确CDC与CDI之间的相关性。
入院后48小时内从肝硬化患者中分离出产毒艰难梭菌菌株，随后进行多位点序列分型（MLST）。根据定植情况将患者分为产毒CDC组和未定植（NC）组。采用逻辑回归分析来分析CDC的危险因素。此外，比较两组的CDI发病率。
104例患者（19.8%）被鉴定为产毒艰难梭菌定植。共鉴定出18种序列类型（STs），其中ST-3、ST-54、ST-35和ST-37为主要类型。Child-Pugh C级（相对危险度，RR，3.025；95%可信区间：1.410 - 6.488）、凝血酶原时间活性（PTA）降低（RR 2.180；95%可信区间：1.368 - 3.476）、血小板减少（RR 2.746；95%可信区间：0.931 - 8.103）以及并发肝性脑病（RR 1.740；95%可信区间：1.012 - 2.990）被确定为肝硬化合并CDC患者的危险因素。CDC组的CDI发病率也显著高于NC组（26.0%对1.7%，P<0.001）。
肝硬化患者中艰难梭菌定植的携带率为19.8%。Child分级C级、PTA和血小板降低以及并发肝性脑病是肝硬化合并艰难梭菌定植患者的危险因素。肝硬化合并艰难梭菌定植的患者更易发生CDI。
