Elgendy Sherein G, Aly Sherine A, Fathy Rawhia, Deaf Enas A E, Abu Faddan Naglaa H, Abdel Hameed Muhamad R
Department of Medical Microbiology and Immunology, School of Medicine, Assiut University, Assiut, Egypt.
Department of Pediatric Medicine, Assiut University Hospitals, Assiut University, Assiut, Egypt.
Iran J Microbiol. 2020 Aug;12(4):296-304. doi: 10.18502/ijm.v12i4.3932.
infection (CDI) has become a significant healthcare-associated infection throughout the world and is particularly important in developing countries. This study aimed to investigate clinical characterization and risk factors related to toxigenic infection in adult and pediatric patients, antimicrobial susceptibility pattern. Also, to evaluate different diagnostic methods for rapid detection of associated diarrhea (CDAD) in Egypt.
Stool samples were collected from 95 pediatric patients and 37 adult patients suffering from antibiotic associated diarrhea and were subjected to direct toxin immunoassay and culture on cycloserine/cefoxitin/fructose agar. The presence of and genes was tested by PCR.
Toxigenic was isolated from pediatric and adult patients at a rate of 17.89% (17/95) and 27% (10/37) respectively. The sensitivity and specificity of direct PCR from stool are (100%, 100% and 82.4%, 100%) in adult and pediatric samples respectively. The susceptibility of to vancomycin and metronidazole were found to be 66.7% and 48.2% respectively.
Diabetes mellitus, prior antibiotic treatment, hematological malignancy on chemotherapy, malnutrition, neutropenia and Ryle feeding are risk factors for development of CDAD. Tight restriction of unnecessary antibiotic uses is necessary in our locality. Direct detection of toxin genes in stool by PCR is sensitive and specific method for early detection of
艰难梭菌感染（CDI）已成为全球重要的医疗相关感染，在发展中国家尤为重要。本研究旨在调查成人和儿童患者中产毒艰难梭菌感染的临床特征、危险因素及抗菌药物敏感性模式。此外，评估埃及快速检测艰难梭菌相关性腹泻（CDAD）的不同诊断方法。
收集95例患有抗生素相关性腹泻的儿科患者和37例成人患者的粪便样本，进行直接毒素免疫测定，并在环丝氨酸/头孢西丁/果糖琼脂上培养。通过PCR检测毒素A和毒素B基因的存在情况。
分别从儿科和成人患者中分离出产毒艰难梭菌，分离率分别为17.89%（17/95）和27%（10/37）。成人和儿科样本中粪便直接PCR的敏感性和特异性分别为（100%，100%）和（82.4%，100%）。发现艰难梭菌对万古霉素和甲硝唑的敏感性分别为66.7%和48.2%。
糖尿病、既往抗生素治疗、化疗中的血液系统恶性肿瘤、营养不良、中性粒细胞减少和鼻饲是发生CDAD的危险因素。在我们地区，必须严格限制不必要的抗生素使用。通过PCR直接检测粪便中的毒素基因是早期检测的敏感且特异的方法。
