Eng Lengsea, Collins Deirdre A, Alene Kefyalew Addis, Bory Sotharith, Theng Youdaline, Vann Pisey, Meng Sreyhuoch, Limsreng Setha, Clements Archie C A, Riley Thomas V
School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia.
Calmette Hospital, Phnom Penh, Cambodia.
Microbiol Spectr. 2025 Apr;13(4):e0274724. doi: 10.1128/spectrum.02747-24. Epub 2025 Feb 19.
Despite high levels of global concern, little is known about the epidemiology of () infection (CDI) in Cambodia. This study aimed to identify the prevalence and risk factors for CDI, and molecular types of in hospitalized adults at Calmette Hospital, Phnom Penh, Cambodia. Stool samples were collected from 263 hospitalized adults between June and September 2022 and tested for using direct and enrichment cultures. PCR toxin genes , and and amplification of the 16s-23s rRNA intergenic spacer region for ribotyping, were performed on all isolates. was isolated from 24% (63/263) of samples, and most isolates were non-toxigenic (67%, 42/63). The five most predominant toxigenic ribotypes (RTs) were RTs 046 (8%, 5/63), 017 (6%, 4/63), 056 (5%, 3/63), 014/020 (5%, 3/63), and 012 (3%, 2/63), and prominent non-toxigenic RTs were QX011 (14%, 9/63), 010 (8%, 5/63), 009 (3%, 2/63), QX021 (3%, 2/63), and QX002 (3%, 2/63). Risk factors significantly associated with CDI included diabetes (odds ratio [OR] = 2.48, 95% confidence interval [CI]: 1.16-5.30) and hospitalization >24 h within the last 3 months before testing (OR = 3.89, 95% CI: 1.79-8.43). It was concluded that most participants from whom was isolated were colonized only; however, a high prevalence of asymptomatic carriage could contribute to silent transmission in healthcare settings and communities. Genotypic identification of local strains is necessary for a better understanding of the epidemiology of CDI and the importance of .
is a significant cause of diarrhea worldwide, initially as a hospital-acquired infection and, more recently, as a community-associated infection. Risk factors for hospital-acquired infection include antimicrobial consumption, extended hospitalization, age ≥ 65 years, and proton pump inhibitor treatment. While much is known about in high-income countries, little is known and there has been less interest in this infection in Asia due to the lack of data. Thus, investigating the prevalence and risk factors for and characterizing strains from hospitalized adults is necessary in Asian countries such as Cambodia. Diabetes and hospitalization >24 h within the last 3 months were identified as risk factors for colonization/infection. The high prevalence of non-toxigenic strains and asymptomatic carriage of in this country were notable. Further studies are warranted to gain better insights into this infection in Cambodia.
尽管全球高度关注，但柬埔寨艰难梭菌感染（CDI）的流行病学情况却鲜为人知。本研究旨在确定柬埔寨金边卡尔梅特医院住院成人中CDI的患病率和危险因素，以及艰难梭菌的分子类型。2022年6月至9月期间，从263名住院成人中收集粪便样本，采用直接培养和增菌培养法检测艰难梭菌。对所有分离出的艰难梭菌进行PCR毒素基因tcdA、tcdB和tcdC检测，以及16s - 23s rRNA基因间隔区扩增用于核糖体分型。24%（63/263）的样本中分离出艰难梭菌，大多数分离株不产毒素（67%，42/63）。五种最主要的产毒素艰难梭菌核糖体分型（RTs）为RTs 046（8%，5/63）、017（6%，4/63）、056（5%，3/63）、014/020（5%，3/63）和012（3%，2/63），突出的非产毒素RTs为QX011（14%，9/63）、010（8%，5/63）、009（3%，2/63）、QX021（3%，2/63）和QX002（3%，2/63）。与CDI显著相关的危险因素包括糖尿病（优势比[OR]=2.48，95%置信区间[CI]：1.16 - 5.30）以及检测前3个月内住院时间>24小时（OR = 3.89，95%CI：1.79 - 8.43）。研究得出结论，大多数分离出艰难梭菌的参与者仅为定植；然而，无症状携带的高患病率可能导致医疗机构和社区中的隐性传播。对当地艰难梭菌菌株进行基因分型对于更好地了解CDI的流行病学以及艰难梭菌的重要性是必要的。
艰难梭菌是全球腹泻的重要病因，最初是医院获得性感染，最近也成为社区相关感染。医院获得性艰难梭菌感染的危险因素包括抗菌药物使用、住院时间延长、年龄≥65岁以及质子泵抑制剂治疗。虽然在高收入国家对艰难梭菌了解很多，但由于缺乏数据，亚洲对这种感染了解甚少且关注较少。因此，在柬埔寨等亚洲国家，调查住院成人中艰难梭菌的患病率和危险因素以及鉴定艰难梭菌菌株特征是必要的。糖尿病和检测前3个月内住院时间>24小时被确定为艰难梭菌定植/感染的危险因素。该国非产毒素菌株的高患病率和艰难梭菌的无症状携带情况值得关注。有必要进一步开展研究以更好地了解柬埔寨的这种感染情况。
