德国艰难梭菌哨点监测系统的实施：2019-2021 年的初步观察结果。
Implementation of a Clostridioides difficile sentinel surveillance system in Germany: First insights for 2019-2021.
机构信息
Institute of Medical Microbiology and Hygiene, University of Saarland, Kirrberger Straße, Building 43, 66421, Homburg/Saar, Germany; Medical Microbiology and Immunology Department, Faculty of Medicine, Mansoura University, El Gomhouria Street, 35516, Mansoura, Egypt; German National Reference Center for Clostridioides (Clostridium) difficile, Homburg/Saar, Münster-Coesfeld, Germany.
Institute of Medical Microbiology and Hygiene, University of Saarland, Kirrberger Straße, Building 43, 66421, Homburg/Saar, Germany; German National Reference Center for Clostridioides (Clostridium) difficile, Homburg/Saar, Münster-Coesfeld, Germany.
出版信息
Anaerobe. 2022 Oct;77:102548. doi: 10.1016/j.anaerobe.2022.102548. Epub 2022 Mar 18.
OBJECTIVES
Clostridioides difficile is a major cause of nosocomial diarrhea. Several "hypervirulent" lineages such as ribotype 027 (RT027) and RT078 are of high epidemiological importance, leading to outbreaks and more severe courses of disease. An active surveillance system targeting molecular epidemiology and corresponding antimicrobial resistance has not been established in Germany.
METHODS
Since October 2019, University Hospitals throughout Germany collected by two dates every year (1st April and October, respectively) their first ten unselected samples being tested positive for C. difficile.
RESULTS
Out of 1026 samples received from 29 sites, 876 toxigenic C. difficile strains could be cultivated. PCR ribotyping of these strains revealed a large strain diversity with RT014 (17.5%) dominating, followed by isolates of the major nosocomial lineage RT001 (7.1%) and the "hypervirulent" lineage RT078 (5.9%). Notably, prevalence of RT027 was low with ∼3.5% at all time points analyzed, while the abundance of RT001 isolates significantly declined from 12.3% to 3.7% during the sampling period (P < 0.001). Antimicrobial resistance against clarithromycin, moxifloxacin, and rifampicin was detected in 18%, 15%, and 4% of the tested isolates, respectively. Highest resistance rates were found among RT027 isolates (83%, 87% and 63% for clarithromycin, moxifloxacin, and rifampicin, respectively). Vancomycin resistance was not detected, and metronidazole resistance was observed only for a single RT027 isolate.
CONCLUSIONS
This Germany-wide continuing surveillance effort with a standardized mode of isolate acquisition indicates that isolates of RT027 were only sporadically detected under these strain acquisition conditions, and RT001 seems to become less important in the hospital setting, being replaced by other RTs.
目的
艰难梭菌是医院获得性腹泻的主要病因。一些“高毒力”谱系，如核糖体型 027（RT027）和 RT078，具有重要的流行病学意义，导致暴发和更严重的疾病病程。德国尚未建立针对分子流行病学和相应抗微生物药物耐药性的主动监测系统。
方法
自 2019 年 10 月以来，德国各大学医院每年通过两种方式（分别为 4 月 1 日和 10 月）收集未经选择的前十份检测出艰难梭菌阳性的样本。
结果
从 29 个地点收到的 1026 个样本中，可培养出 876 株产毒艰难梭菌菌株。这些菌株的 PCR 核糖分型显示出很大的菌株多样性，以 RT014（17.5%）为主，其次是主要医院谱系 RT001（7.1%）和“高毒力”谱系 RT078（5.9%）。值得注意的是，在所有分析的时间点，RT027 的流行率均较低，约为 3.5%，而 RT001 分离株的丰度在采样期间从 12.3%显著下降至 3.7%（P<0.001）。对克拉霉素、莫西沙星和利福平的抗药性分别在 18%、15%和 4%的测试分离株中被检测到。RT027 分离株的抗药性最高（克拉霉素、莫西沙星和利福平的耐药率分别为 83%、87%和 63%）。未检测到万古霉素耐药性，仅在一个 RT027 分离株中观察到甲硝唑耐药性。
结论
这项德国范围内的持续监测工作采用标准化的分离株获取模式，表明在这些菌株获取条件下，RT027 分离株只是零星被检出，而 RT001 在医院环境中似乎变得不那么重要，被其他 RT 取代。
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