摘要
目的回顾性调查4年期间某综合性医院血液病患者艰难梭菌感染发生情况及临床特征,用核糖体分型技术分析艰难梭菌的分子流行病学及院内传播的风险。方法2019年7月—2023年7月,从血液病房患者腹泻粪便样本中分离出艰难梭菌;用聚合酶链式反应(PCR)检测毒素基因tcdA、tcdB和二元毒素基因(cdtA、cdtB);毛细管凝胶电泳核糖体分型技术对产毒菌株进行分型研究。结果共分离得到130株产毒艰难梭菌,其中毒素A和B均阳性(A+B+)菌株116株(116/130,89.2%);毒素A阴性而毒素B阳性(A-B+)菌株14株(14/130,10.8%);130株产毒菌株中二元毒素阳性菌株7株(A+B+CDT+)(7/130,5.4%)。PCR核糖体分型将130株产毒艰难梭菌分为9个克隆群,同源性分析发现产毒素艰难梭菌在不同楼层病房之间以及同一病房不同时间有一定的流行。结论针对免疫功能低下患者,如血液恶性疾病患者,应提高临床医生对艰难梭菌感染的诊疗意识;同时可应用相应的分子流行病学分析监测聚集性病例菌株,对污染的医疗环境进行严格消毒,医护人员严格执行手卫生,实施有效的感染控制,从而减少艰难梭菌院内暴发流行。
Objective To retrospectively investigate the occurrence and clinical characteristics of Clostridium difficile(C.difficile)infection in hematology patients in a comprehensive hospital over four years and to analyze the molecular epidemiology of C.difficile and the risk of nosocomial transmission using ribotyping.Methods C.difficile was isolated from diarrheal fecal samples of patients in the hematology ward from July 2019 to July 2023.Detection of toxin genes(tcdA,tcdB,cdtA,and cdtB)by polymerase chain reaction(PCR).Toxigenic strains were typed by capillary electrophoresis(CE)ribotyping.Results A total of 130 strains of toxin producing C.difficile were isolated,of which 116 strains(89.2%)were positive for both tcdA and tcdB(A+B+);tcdA-negative but tcdB-positive(A-B+)strains were 14(10.8%);and 7 strains(5.4%)were positive for binary toxin genes(A+B+CDT+)among the 130 toxin producing strains.PCR ribotyping classified the 130 toxigenic C.difficile strains into nine clonal groups,and homology analysis revealed that toxigenic C.difficile strains were prevalent between wards on different floors and at different times in the same ward.Conclusion For immunocompromised patients,such as patients with hematologic malignant diseases,clinicians'awareness of C.difficile infections should be improved.Meanwhile,molecular epidemiological analyses can be applied to monitor the strains of clustered cases,contaminated healthcare environments can be strictly disinfected,healthcare workers can strictly perform hand hygiene,and effective infection control can be performed to reduce nosocomial outbreaks of C.difficile.
作者
郑丽思
赵帆
朱嘉梁
吕涛
Zheng Lisi;Zhao Fan;Zhu Jialiang;Lyu Tao(State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,the First Affiliated Hospital,School of Medicine,Zhejiang University,Hangzhou 310003;Laboratory Medicine College of Wenzhou Medical University,Wenzhou 325035)
出处
《中国抗生素杂志》
北大核心
2025年第2期121-128,共8页
Chinese Journal of Antibiotics
基金
国家重点研发计划资助(No.2020YFE0204300)。
关键词
艰难梭菌感染
血液病
PCR核糖体分型
分子流行病学
Clostridium difficile infection
Hematological disease
PCR ribotyping
Molecular epidemiology
