Zhou Y, Wu Y, Zeng H, Chen C, Xie Q, He L
School of Public Health, Xiangnan University, Chenzhou 423000, China.
National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2024 May 20;44(5):998-1003. doi: 10.12122/j.issn.1673-4254.2024.05.23.
OBJECTIVE: To investigate the characteristics of infection (CDI) in patients hospitalized for diarrhea and analyze the risk factors for CDI. METHODS: Stool samples were collected from 306 patients with diarrhea hospitalized in 3 university hospitals in a mid-south city of China from October to December, 2020. . was isolated by anaerobic culture, and qRT-PCR was used to detect the expressions of toxin A () and B () genes and the binary toxin genes ( and ). Multilocus sequence typing (MLST) was performed for the isolated strains without contaminating strains as confirmed by 16S rDNA sequencing. Etest strips were used to determine the drug resistance profiles of the isolated strains, and the risk factors of CDI in the patients were analyzed. RESULTS: CDI was detected in 25 (8.17%) out of the 306 patients. All the patients tested positive for and but negative for the binary toxin genes. Seven noncontaminated . strains with 5 ST types were isolated, including 3 ST54 strains and one strain of ST129, ST98, ST53, and ST631 types each, all belonging to clade 1 and sensitive to metronidazole and vancomycin. Hospitalization within the past 6 months (= 3.675; 95% : 1.405-9.612), use of PPIs (=7.107; 95% : 2.575-19.613), antibiotics for ≥1 week (=7.306; 95% : 2.274-23.472), non-steroidal anti-inflammatory drugs (=4.754; 95% : 1.504-15.031) in the past month, and gastrointestinal disorders (=5.050; 95% : 1.826-13.968) were all risk factors for CDI in the patients hospitalized for diarrhea. CONCLUSION: The CDI rate remains low in the hospitalized patients with diarrhea in the investigated hospitals, but early precaution measures are recommended when exposure to the risk factors is reported to reduce the risk of CDI in the hospitalized patients.
目的:调查因腹泻住院患者的艰难梭菌感染(CDI)特征,并分析CDI的危险因素。 方法:收集2020年10月至12月在中国中南部一座城市的3所大学医院住院的306例腹泻患者的粪便样本。通过厌氧培养分离出菌株,采用qRT-PCR检测毒素A()和B()基因以及二元毒素基因(和)的表达。对经16S rDNA测序确认无污染菌株的分离株进行多位点序列分型(MLST)。使用Etest试纸条确定分离株的耐药谱,并分析患者中CDI的危险因素。 结果:306例患者中有25例(8.17%)检测出CDI。所有患者的和检测均为阳性,但二元毒素基因检测为阴性。分离出7株无污染的菌株,有5种ST型,包括3株ST54菌株,以及各1株ST129、ST98 ST53和ST631型菌株,均属于进化枝1,对甲硝唑和万古霉素敏感。过去6个月内住院(=3.675;95%可信区间:1.405 - 9.612)、使用质子泵抑制剂(=7.107;95%可信区间:2.575 - 19.613)、使用抗生素≥1周(=7.306;95%可信区间:2.274 - 23.472)、过去1个月内使用非甾体抗炎药(=4.754;95%可信区间:1.504 - 15.031)以及胃肠道疾病(=5.050;95%可信区间:1.826 - 13.968)均为腹泻住院患者发生CDI的危险因素。 结论:在所调查医院中,腹泻住院患者的CDI发生率仍然较低,但当报告存在危险因素暴露时,建议采取早期预防措施以降低住院患者发生CDI的风险。
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