Wang Baoya, Dong Wenjuan, Ma Liyan, Dong Yonghui, Wang Shanmei, Yuan Youhua, Ma Qiong, Xu Junhong, Yan Wenjuan, Nan Jing, Zhang Qi, Xu Wenbo, Ma Bing, Chu Yafei, Zhang Jiangfeng, Li Li, Li Yi
Department of Clinical Microbiology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, and People's Hospital of Henan University, Zhengzhou, 450003, Henan, People's Republic of China.
Department of Clinical Microbiology, Xicheng District Pingan Hospital, Beijing, 100035, People's Republic of China.
Infect Drug Resist. 2021 Nov 15;14:4783-4793. doi: 10.2147/IDR.S338593. eCollection 2021.
This study aimed to investigate the prevalence, genetic diversity and clinical characteristics of isolates from hospitalized clinical diarrheal patients.
A prospective study was conducted on 1108 patients with diarrhea during hospitalization. Stool samples were cultured for , and the toxin genes were detected by PCR. The available clinical data of 112 patients were analyzed to study the clinical features of various isolates. Multi-locus sequence typing (MLST) was performed to assess phylogenetic relationship between different isolates.
A total of 153 (13.8%) isolates were obtained from patients' stools. type F (49.0%) was the major toxin type in the isolates, followed by type A (n = 59, 38.6%) and type C (n = 14, 9.2%). Patients older than 50 years and those with underlying diseases of cancer, hepatobiliary system, and ulcerative colitis (UC) were more predisposed to type F and type A infection than to type C. The patients infected with type C experienced more severe clinical symptoms compared to those with type A infection. There was a significant association between type F and foodborne gastrointestinal (GI) diseases (p = 0.018), between type F and antibiotic-associated diarrhea (AAD) (p < 0.001), and between type A and sporadic diarrhea (SD) (p < 0.001). Phylogenetic analysis indicated that type F isolates carrying a chromosomal gene mainly belonged to ST77 (6/15 isolates). Type F isolates with gene on a plasmid exhibited high genetic diversity.
High prevalence and considerable genetic diversity of type F were found in clinical diarrheal patients. Elderly people and patients with cancer, hepatobiliary diseases or UC, or suspected of having food poisoning (FP) may be targeted for routine testing of toxin genes and may benefit from early detection of type C isolates that cause more severe clinical symptoms.
本研究旨在调查住院临床腹泻患者分离株的流行情况、基因多样性和临床特征。
对1108例住院腹泻患者进行前瞻性研究。采集粪便样本进行培养，并通过PCR检测毒素基因。分析112例患者的可用临床数据，以研究各种分离株的临床特征。进行多位点序列分型（MLST）以评估不同分离株之间的系统发育关系。
共从患者粪便中获得153株（13.8%）分离株。F型（49.0%）是分离株中的主要毒素类型，其次是A型（n = 59，38.6%）和C型（n = 14，9.2%）。50岁以上的患者以及患有癌症、肝胆系统和溃疡性结肠炎（UC）等基础疾病的患者比C型感染更容易感染F型和A型。与A型感染患者相比，C型感染患者的临床症状更严重。F型与食源性胃肠道（GI）疾病之间存在显著关联（p = 0.018），F型与抗生素相关性腹泻（AAD）之间存在显著关联（p < 0.001），A型与散发性腹泻（SD）之间存在显著关联（p < 0.001）。系统发育分析表明，携带染色体基因的F型分离株主要属于ST77（15株中的6株）。质粒上带有基因的F型分离株表现出高度的遗传多样性。
临床腹泻患者中F型的流行率较高且基因多样性相当。老年人以及患有癌症、肝胆疾病或UC或疑似食物中毒（FP）的患者可能是毒素基因常规检测的目标人群，并且可能受益于早期检测出导致更严重临床症状的C型分离株。
