越南成人腹泻患者中的艰难梭菌（梭状芽孢杆菌）。

Clostridioides (Clostridium) difficile in adults with diarrhoea in Vietnam.

机构信息

School of Biomedical Sciences, The University of Western Australia, Western Australia, Australia.

Thai Binh University of Medicine and Pharmacy, Thai Binh, Viet Nam.

出版信息

Anaerobe. 2023 Jun;81:102741. doi: 10.1016/j.anaerobe.2023.102741. Epub 2023 May 25.

DOI:10.1016/j.anaerobe.2023.102741

PMID:37244476

Abstract

BACKGROUND

Clostridioides (Clostridium) difficile causes antimicrobial-associated diarrhoea, however, presentations may range from asymptomatic carriage to severe diarrhoea, life-threatening toxic megacolon and even death. Reports on C. difficile infection (CDI) in Vietnam remain limited. The objectives of this study were to evaluate the epidemiology, molecular characteristics, and antimicrobial susceptibility of C. difficile isolated from adults with diarrhoea in Vietnam.

METHODS

Diarrhoeal stool samples from adult patients aged ≥17 years old were collected at Thai Binh General Hospital in northern Vietnam between March 1, 2021 and February 28, 2022. All samples were transported to The University of Western Australia, Perth, Western Australia for C. difficile culture, toxin gene profiling, PCR ribotyping and antimicrobial susceptibility testing.

RESULTS

A total of 205 stool samples were collected from patients aged from 17 to 101 years old. The overall prevalence of C. difficile was 15.1% (31/205) with the recovery of toxigenic and non-toxigenic isolates 9.8% (20/205) and 6.3% (13/205), respectively. Thus 33 isolates were recovered comprising 18 known ribotypes (RTs) and one novel RT (two samples contained two different RTs in each sample). The most prevalent strains were RT 012 (five strains) and RTs 014/020, 017 and QX 070 three strains each. All C. difficile were susceptible to amoxicillin/clavulanate, fidaxomicin, metronidazole, moxifloxacin and vancomycin, while resistance to varying degrees was seen to clindamycin, erythromycin, tetracycline and rifaximin, 78.8% (26/33), 51.5% (17/33), 27.3% (9/33) and 6.1% (2/33), respectively. The prevalence of multidrug resistance was 27.3% (9/33) and multidrug resistance was most common in toxigenic RT 012 and non-toxigenic RT 038 strains.

CONCLUSION

The prevalence of C. difficile in adults with diarrhoea and multidrug resistance in C. difficile isolates was relatively high. A clinical assessment to differentiate between CDI/disease and colonisation is required.

摘要

背景

艰难梭菌（梭状芽孢杆菌）可引起抗菌药物相关性腹泻，但临床表现可从无症状带菌到严重腹泻、危及生命的中毒性巨结肠，甚至死亡不等。有关越南艰难梭菌感染（CDI）的报告仍然有限。本研究的目的是评估艰难梭菌从越南成年腹泻患者中分离的流行病学、分子特征和抗菌药物敏感性。

方法

2021 年 3 月 1 日至 2022 年 2 月 28 日，在越南北部的太平综合医院采集了年龄在 17 岁及以上的成年患者的腹泻粪便样本。所有样本均被运至西澳大利亚珀斯的西澳大学，进行艰难梭菌培养、毒素基因分析、PCR 核糖体分型和抗菌药物敏感性试验。

结果

共采集了 205 份来自 17 至 101 岁患者的粪便样本。艰难梭菌的总检出率为 15.1%（31/205），其中产毒株和非产毒株的检出率分别为 9.8%（20/205）和 6.3%（13/205）。因此，共分离出 33 株菌，包括 18 种已知的核糖体分型（RT）和一种新的 RT（每个样本中两个样本各包含两种不同的 RT）。最常见的菌株为 RT 012（5 株）、RT 014/020、017 和 QX 070（各 3 株）。所有艰难梭菌对阿莫西林/克拉维酸、非达霉素、甲硝唑、莫西沙星和万古霉素均敏感，而克林霉素、红霉素、四环素和利福昔明的耐药率分别为 78.8%（26/33）、51.5%（17/33）、27.3%（9/33）和 6.1%（2/33）。多药耐药率为 27.3%（9/33），产毒 RT 012 和非产毒 RT 038 菌株中多药耐药最为常见。