Martirosian G, Kuipers S, Verbrugh H, van Belkum A, Meisel-Mikolajczyk F
Department of Clinical Bacteriology, Medical Academy, Warsaw, Poland.
J Clin Microbiol. 1995 Aug;33(8):2016-21. doi: 10.1128/jcm.33.8.2016-2021.1995.
Detection of the source of Clostridium difficile strains is of importance for the control of the nosocomial spread of this microorganism. For this purpose, vaginal and rectal swabs from 183 mothers, duplicate fecal samples (taken on days 1 and 4 after birth) from 183 neonates, and 94 environmental samples were cultured for C. difficile. The microorganism was never detected in the meconium obtained on day 1 after birth. On the other hand, an incidence of 17% C. difficile positivity was noted in the fecal samples obtained on day 4 after birth. Forty-two percent of the 31 colonized neonates had been delivered with complications. The bacteria were never encountered in the rectal swabs of the mothers, and C. difficile was identified in only one vaginal swab. In contrast, 13% of the environmental samples were positive for C. difficile. No major difference was encountered between patient and environmental isolates with respect to toxigenicity (58 to 65% toxigenic isolates). All strains were subsequently typed by PCR amplification of the 16S-23S ribosomal intergenic spacer regions and by arbitrarily primed PCR (AP-PCR) with different primers and combinations thereof. All environmental isolates and 11 of 31 neonatal strains were of a single type. The vaginal strain was unique, and among the maternity ward- and neonate-related isolates, only two additional AP-PCR types were identified. When a collection of C. difficile strains from patients hospitalized in other institutions and suffering from antibiotic-associated diarrhea or pseudomembranous colitis was analyzed in a similar manner, it appeared that the strain from the maternity ward was unique. The other strain commonly encountered among the neonates was also identified frequently among the isolates from patients with antibiotic-associated diarrhea or pseudomembranous colitis, indicating its general occurrence. On the basis of both epidemiological studies and PCR-mediated genotyping, it was shown that the environment and not the birth canal is the major source of C. difficile acquisition by neonates in this maternity hospital setting. Furthermore, AP-PCR appears to be a fast and useful method for epidemiologically relevant typing of C. difficile isolates.
艰难梭菌菌株来源的检测对于控制该微生物在医院内的传播至关重要。为此，对183名母亲的阴道和直肠拭子、183名新生儿的重复粪便样本（出生后第1天和第4天采集）以及94份环境样本进行了艰难梭菌培养。出生后第1天获得的胎粪中从未检测到该微生物。另一方面，出生后第4天获得的粪便样本中艰难梭菌阳性率为17%。31名定植新生儿中有42%是并发症分娩。母亲的直肠拭子中从未发现该细菌，仅在一份阴道拭子中鉴定出艰难梭菌。相比之下，13%的环境样本艰难梭菌呈阳性。在产毒性方面（产毒分离株占58%至65%），患者和环境分离株之间未发现重大差异。随后，通过对16S - 23S核糖体基因间隔区进行PCR扩增以及使用不同引物及其组合进行任意引物PCR（AP - PCR）对所有菌株进行分型。所有环境分离株以及31株新生儿菌株中的11株属于单一类型。阴道菌株是独特的，在产科病房和新生儿相关分离株中，仅鉴定出另外两种AP - PCR类型。当以类似方式分析从其他机构住院且患有抗生素相关性腹泻或假膜性结肠炎的患者中收集的艰难梭菌菌株时，发现产科病房的菌株是独特的。在新生儿中常见的另一种菌株在患有抗生素相关性腹泻或假膜性结肠炎患者的分离株中也经常被鉴定出，表明其普遍存在。基于流行病学研究和PCR介导的基因分型，结果表明在该产科医院环境中，环境而非产道是新生儿获得艰难梭菌的主要来源。此外，AP - PCR似乎是一种快速且有用的对艰难梭菌分离株进行流行病学相关分型方法。
