背景:艰难梭菌是一种引起抗生素相关性感染性腹泻和假膜性小肠结肠炎的细菌。近年来,艰难梭菌感染(CDI)在中国的影响受到了广泛关注。然而,重庆的流行病学数据很少,位于中国西南部的一个城市。本研究旨在调查重庆地区艰难梭菌CDI的流行病学特征及耐药情况。
方法:采用病例对照研究方法,探讨艰难梭菌的临床感染特点和易感因素。通过测试毒素基因和使用多基因座序列分型(MLST)评价艰难梭菌分离物的特征。使用琼脂稀释技术确定菌株对9种抗生素的敏感性。
结果:在2084例腹泻患者中,90个产毒艰难梭菌菌株的分离检测呈阳性,导致CDI患病率为4.32%。四环素,头孢菌素,肝胆疾病,和胃肠道疾病被确定为CDI发病率的独立危险因素。90株分为21种序列类型(ST),ST3是最常见的(n=25,27.78%),其次是ST2(n=10,11.11%)和ST37(n=9,10%)。确定了三种不同的毒素类型:69(76.67%)是ABCDT-,12(13.33%)为A-B+CDT-,9(10%)为A+B+CDT+。尽管对红霉素有相当大的耐药性(73.33%),莫西沙星(62.22%),和克林霉素(82.22%),没有一个分离株对万古霉素表现出耐药性,替加环素,或者甲硝唑.此外,不同的毒素类型显示不同的抗微生物特性。
结论:在重庆鉴定的菌株,中国西南地区,表现出很高的遗传多样性。加强对HA-CDI感染高危患者的充分认识,特别是那些患有胃肠道和肝细胞疾病的人,并强调谨慎使用四环素和卡培他滨。这些发现表明,未来可能会发生CDI的潜在流行,强调需要及时监测。
BACKGROUND: Clostridioides difficile is a bacterium that causes antibiotic-associated infectious diarrhea and pseudomembranous enterocolitis. The impact of C. difficile infection (CDI) in China has gained significant attention in recent years. However, little epidemiological data are available from Chongqing, a city located in Southwest China. This
study aimed to investigate the epidemiological pattern of CDI and explore the drug resistance of C. difficile isolates in Chongqing.
METHODS: A case-control
study was conducted to investigate the clinical infection characteristics and susceptibility factors of C. difficile. The features of the C. difficile isolates were evaluated by testing for toxin genes and using multi-locus sequence typing (MLST). The susceptibility of strains to nine antibiotics was determined using agar dilution technique.
RESULTS: Out of 2084 diarrhea patients, 90 were tested positive for the isolation of toxigenic C. difficile strains, resulting in a CDI prevalence rate of 4.32%. Tetracycline, cephalosporins, hepatobiliary disease, and gastrointestinal disorders were identified as independent risk factors for CDI incidence. The 90 strains were classified into 21 sequence types (ST), with ST3 being the most frequent (n = 25, 27.78%), followed by ST2 (n = 10, 11.11%) and ST37 (n = 9, 10%). Three different toxin types were identified: 69 (76.67%) were A+B+CDT-, 12 (13.33%) were A-B+CDT-, and 9 (10%) were A+B+CDT+. Although substantial resistance to erythromycin (73.33%), moxifloxacin (62.22%), and clindamycin (82.22%), none of the isolates exhibited resistance to vancomycin, tigecycline, or metronidazole. Furthermore, different toxin types displayed varying anti-microbial characteristics.
CONCLUSIONS: The strains identified in Chongqing, Southwest China, exhibited high genetic diversity. Enhance full awareness of high-risk patients with HA-CDI infection, particularly those with gastrointestinal and hepatocellular diseases, and emphasize caution in the use of tetracycline and capecitabine. These findings suggest that a potential epidemic of CDI may occur in the future, emphasizing the need for timely monitoring.