上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

住院腹泻患者艰难梭菌感染的临床特点分析

高燕婷1，章黎华2，王 粟1，冯佩佩1，姚淑娴1，赵 悦1，彭奕冰2   

  1. 上海交通大学 医学院 1.检验系 2.附属瑞金医院检验科， 上海 200025
  • 出版日期:2014-10-28 发布日期:2014-10-28
  • 通讯作者: 彭奕冰, 电子信箱: pyb9861@sohu.com。
  • 作者简介:高燕婷（1992—）， 女， 本科生; 电子信箱: gyt025@sina.com。
  • 基金资助:

    上海市科委科研计划项目（12JC1406100）

Analysis of clinical characteristics of Clostridium difficile infection for hospitalized patients with diarrhea

GAO Yan-ting1, ZHANG Li-hua2, WANG Su1, FENG Pei-pei1, YAO Shu-xian1, ZHAO Yue1, PENG Yi-bing2   

  1. 1.Department of Laboratory Medicine, Shanghai Jiao Tong University School of Medicine，Shanghai 200025, China； 2.Clinical Laboratory, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Online:2014-10-28 Published:2014-10-28
  • Supported by:

    Scientific Research Project of Science and Technology Commission of Shanghai Municipality, 12JC1406100

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摘要：

目的 分析上海交通大学医学院附属瑞金医院住院腹泻患者艰难梭菌感染情况及临床特点。方法 收集上海交通大学医学院附属瑞金医院2013年11月—2014年2月住院腹泻患者的不成形粪便标本706份，通过厌氧培养、乳胶凝集试验和谷氨酸脱氢酶基因（gluD）扩增，分离鉴定艰难梭菌。应用聚合酶链反应（PCR）对菌株的DNA进行毒素A基因（tcdA）和毒素B基因（tcdB）检测，分析菌株的毒素类型。根据患者病史信息，分析其临床表现和用药情况。结果 706份标本中分离得到艰难梭菌菌株34株（4.82%），来自30例住院患者；其中院内感染艰难梭菌的住院患者为23例（76.67%），均使用过头孢类、碳青霉烯类、喹诺酮类等抗生素中的1种或多种。经PCR检测菌株毒素，发现34株艰难梭菌中毒素类型为A+B+型共21株（61.76%），A-B+型12株（35.30%），A-B-型仅1株（2.94%）。结论 上海交通大学医学院附属瑞金医院住院腹泻患者中艰难梭菌感染以院内感染为主，感染菌株的毒素类型以A+B+型为主，抗生素的使用是导致艰难梭菌感染的重要因素。

关键词: 艰难梭菌, 腹泻, 毒素, 临床特点

Abstract:

Objective To analyze the clinical characteristics of Clostridium difficile (C.difficile) infection for hospitalized patients with diarrhea in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. Methods A total of 706 unformed stool samples of hospitalized patients with diarrhea from November 2013 to February 2014 were collected. The anaerobic culture, latex agglutination test, and glutamate dehydrogenase gene (gluD) amplification were performed for identification of C.difficile strains. The DNA of strains was detected by the polymerase chain reaction (PCR) for the toxin A gene (tcdA) and toxin B gene (tcdB), and toxin types of the strains were analyzed. Clinical symptoms and medications of patients were analyzed based on their medical history. Results Among 706 samples, 34 C.difficile strains (4.82%) from 30 hospitalized patients were isolated. The C.difficile infection of 23 patients was nosocomial infection (76.67%) and they all had used one or more antibiotics, including cephalosporins, carbopenems, quinolones, etc. The toxin detection by the PCR showed that among 34 C.difficile strains, the toxin type of 21 strains were A+B+ type (61.76%); 12 strains were A-B+ type (35.30%); and only 1 strain was A-B- type (2.94%). Conclusion The C.difficile infection of most patients with diarrhea in Ruijin Hospital is nosocomial infection. The toxin type of strains is mainly A+B+ type. The use of antibiotics is an important factor of C.difficile infection.

Key words: Clostridium difficile, diarrhea, toxin, clinical characteristics