欢迎来到《四川大学学报(医学版)》

ICU病房的非艰难梭菌相关性医院感染腹泻

Nosocomial Diarrhea in Intensive Care Unit: other than Clostridium difficile

  • 摘要: 目的 了解三甲医院ICU病房非艰难梭菌医院感染腹泻患者产酸克雷伯菌和产气荚膜梭菌的感染率及临床特点,以期对ICU病房细菌性医院感染腹泻患者的诊治思路提供基础数据。 方法 收集四川大学华西医院综合ICU病房2012年4~11月非艰难梭菌医院感染腹泻102例患者的粪便,PCR检测产酸克雷伯菌毒素基因pehX,产气荚膜梭菌菌种鉴定16S rRNA基因和毒素基因cpa、cpe,空肠弯曲菌菌种鉴定16S rRNA基因、mapA基因及毒素基因hipO。PCR阳性产物双向测序并用工具BLAST算法进行比对。总结产毒菌株检测阳性的医院感染腹泻患者的临床特点。 结果 102例非艰难梭菌医院感染腹泻患者的粪便中检出产毒的产酸克雷伯菌和产毒的产气荚膜梭菌各4例,各占非艰难梭菌相关性医院感染腹泻的3.9%。没有检出产毒的空肠弯曲菌。大多数检测阳性的患者都有严重的基础疾病,都在使用强有力干扰肠道正常菌群的抗菌药物,预后都很差。 结论 尽管我院ICU病房非艰难梭菌相关医院感染腹泻的患者粪便中产毒产酸克雷伯菌和产气荚膜梭菌的检出率较低,但这两种菌感染的患者都有严重的基础疾病且预后不良。

     

    Abstract: Objective To investigate the incidence and clinical features of non-Clostridium difficile (C.difficile) associated nosocomial diarrhea in intensive care unit (ICU) caused by Klebsiella oxytoca and Clostridium perfringens. Methods The faeces of 102 patients with non-C.difficile associated nosocomial diarrhea in ICU of West China Hospital, were collected during April to November, 2012. The target bacterial genes were detected by PCR amplification and sequencing, including toxic gene pehX of Klebsiella oxytoca, species-specific 16S rRNA gene and toxic gene cpa and cpe of Clostridium perfringens, species-specific 16S rRNA gene with mapA and toxic gene hipO of Campylobacter jejuni. Clinical features of the patients with positive results were summarized. Results Among 102 patients with non-C.difficile associated nosocomial diarrhea, 4 patients (3.9%) were detected with toxic Klebsiella oxytoca while 4 patients (3.9%) were detected with toxic Clostridium perfringens. No toxic Campylobacter jejuni was detected. Most of the patients had severe underlying diseases and poor final outcome, accepted potent antibiotics which disturbed intestinal flora obviously.. Conclusion Non-C.difficile associated nosocomial diarrhea in ICU caused by Klebsiella oxytoca is and Clostridium perfringens is associated with severe diseases and poor outcome, but the incidence in our hospital is relatively low in our hospital.

     

/

返回文章
返回