Mihajlov Kiril, Andreska Aneta, Ristovska Nadica, Grdanoska Tatjana, Trajkovska-Dokic Elena
Institute of Microbiology and Parasitology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia.
Open Access Maced J Med Sci. 2019 Jun 30;7(12):1896-1899. doi: 10.3889/oamjms.2019.482.
is a major nosocomial pathogen. In Europe, this bacterium is mostly characterised by PCR ribotyping. Most of the infections (CDI) are treated with vancomycin or metronidazole, although prolonged antibiotic use is considered as one of the main risk factors for CDI.
This study aimed to detect the presence of various ribotypes in hospitalised patients and to investigate their toxigenicity and antibiotic susceptibility.
All stool samples obtained from each patient were inoculated on Columbia blood agar and cycloserine cefoxitine fructose agar (CCFA) for isolation of . Glutamate dehydrogenase and toxins A and B were investigated by immunochromatographic tests. Final confirmation of the isolates was performed by Vitek 2 and MALDI-TOF. A total of 21 isolates were collected for further investigation. PCR ribotyping was performed as described by Janezic and Rupnik. PCR ribotype profiles were analysed using software (Bionumerics, Applied Maths). Antibiotic susceptibility was determined by E-tests for metronidazole, vancomycin, tetracycline, clindamycin, erythromycin, imipenem, ciprofloxacin and moxifloxacin.
About 48% of isolates belonged to ribotype 001/072. So, this ribotype was the most common ribotype in this study. The remaining 52% of isolates consisted of 10 different ribotypes: 017, SLO 160, SLO 187, SLO 120, 255/258, 014/020, 046, 002, 070 and 027. Furthermore, 20 (95.2 %) out of 21 isolates of were toxigenic. Toxins A and B were detected simultaneously in 90.5 % of isolates. Two isolates from the ribotype 017 were toxin B positive only. Treatments with any of the following antimicrobials: clindamycin, erythromycin, ciprofloxacin and moxifloxacin (as well as many other antibiotics), could be a risk factor for CDI due to the high resistance of the strains in this study. About 90% of the strains from the most common ribotype 001/072 have MICs for clindamycin and erythromycin > 256 µg/ml.
All strains isolated are highly resistant to ciprofloxacin. All strains were susceptible to vancomycin (median MIC was 0.63 µg/ml) and metronidazole (median MIC was 0.084 µg/ml), so these two antimicrobials remain optimal treatment option for CDI.
是一种主要的医院病原体。在欧洲，这种细菌主要通过PCR核糖体分型来表征。大多数艰难梭菌感染（CDI）用万古霉素或甲硝唑治疗，尽管长期使用抗生素被认为是CDI的主要危险因素之一。
本研究旨在检测住院患者中各种艰难梭菌核糖体分型的存在情况，并调查其产毒性和抗生素敏感性。
从每位患者采集的所有粪便样本接种于哥伦比亚血琼脂和环丝氨酸头孢西丁果糖琼脂（CCFA）上以分离艰难梭菌。通过免疫色谱试验检测谷氨酸脱氢酶以及毒素A和B。分离株的最终鉴定通过Vitek 2和基质辅助激光解吸电离飞行时间质谱（MALDI-TOF）进行。总共收集了21株分离株用于进一步研究。按照Janezic和Rupnik所述进行PCR核糖体分型。使用软件（Bionumerics，应用数学公司）分析PCR核糖体分型图谱。通过E试验测定甲硝唑、万古霉素、四环素、克林霉素、红霉素、亚胺培南、环丙沙星和莫西沙星的抗生素敏感性。
约48%的艰难梭菌分离株属于核糖体分型001/072。因此，该核糖体分型是本研究中最常见的核糖体分型。其余52%的艰难梭菌分离株由10种不同的核糖体分型组成：017、SLO 160、SLO 187、SLO 120、255/258、014/020、046、002、070和027。此外，21株艰难梭菌分离株中有20株（95.2%）产毒。90.5%的艰难梭菌分离株同时检测到毒素A和B。核糖体分型017的两株分离株仅毒素B呈阳性。由于本研究中菌株的高耐药性，使用以下任何一种抗菌药物治疗：克林霉素、红霉素、环丙沙星和莫西沙星（以及许多其他抗生素），都可能是CDI的危险因素。最常见的核糖体分型001/072中约90%的菌株对克林霉素和红霉素的最低抑菌浓度（MIC）>256μg/ml。
所有分离出的菌株对环丙沙星高度耐药。所有菌株对万古霉素（中位MIC为0.63μg/ml）和甲硝唑（中位MIC为0.084μg/ml）敏感，因此这两种抗菌药物仍然是CDI的最佳治疗选择。
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