The Analysis Of Molecular Epidemiological Characteristics Of Nosocomial Clostridium Difficile Infection

Objective: clostridium difficule is a gram positive specific anaerobic bacillus.With the increasing use of a variety of antimicrobial agents,especially the widespread use of broad spectrum antibiotics,clostridium difficile gradually became the most common pathogen of antibiotic-Associated Diarrhea.The main clinical manifestations of clostridium difficilte infection were fever,abdominal pain and watery diarrhea.The mild patients were self-limited,severe patients could cause pseudomembranous colitis,and complications such as toxic megacolon,intestinal perforation,septic shock,and even death.In the last decade of the twentieth century,the incidence of CDI was increasing,and the high toxicity strain represented by ribosome type 027 was the main cause of the increase of clostridium difficile infection and severe infection.It is difficult to operate in laboratory because of low sensitivity of C lostridium difficile detection and harsh isolation and culture conditions.Due to its lower sensitivity and strain of C lostridium difficile isolated and cultured under harsh conditions,large difficulty of laboratory operation,only a single hospital or department reports.The Surveillance and study of clostridium difficile infection in C hina has not formed a nationwide system.There are no related reports in Shenyang and surrounding area.This study is to investigate the clinical characteristics of clostridium difficile infection in the First Hospital of China Medical University and analyze the epidemiological characterist ics of the pathogenic strain.Methods : We will collect the specimens of patients with diarrhea in the First Hospital of China Medical University,and test the specimens for A/B Toxin(FEIA),toxin gene(q PCR),anaerobic culture and identification.Analyze the clinic features of the subject。Results: There were 4 positive,with a positive rate of 8.2 % of the 49 samples.13 positive copies of the B toxin gene,with a positive rate of 26.53 %.13 samples were anaerobic culture positive,positive rate 26.53 %;A cdt gene positive,positive rate of 2.04 %;The sensitivity and specificity of toxin test were 36.3 % and 100 % respectively.No type027 were detected in this test.O f the 44 subjects,only 4 were positive for A/B toxin,tcd B gene,anaerobic culture,7 were negative for A/B toxin,positive for tcd B gene and anaerobic culture,1 were negative for A/B Toxin and tcd B gene,positive for anaerobic culture,and 32 were negative for A/B toxin,tcd B gene and anaerobic culture.All subjects had clinical manifestations of diarrhea,and without diagnosis of pseudomembranous colitis.There were 13 cases of clostridium diffic ile infection and 1 case of non-toxic clostridium difficile infection.The sensitivity and specificity of Xpert were 90.9 % and 97.0 %,decreasing of the lymphocyte ratio,increasing of the granulocyte ratio,and three-generation cephalosporins and combine with two or more antibacterial drugs were risk factors..Conclusion: Research shows that the NAAT+EIA method based on Xpert detection kit and bio Merieux can be used for clinical detection of pathogenic C lostridium difficile infection,but because of the small sample size,its effectiveness still need further verification.The positive rate of 25% of C lostridium difficile infection in our hospital by NAAT+EIA was slightly higher than the average rate of other 19% other studies in China.All CDI positive cases were scattered in multiple time periods and departments,all were sporadic cases.During the study,there was no outbreak and epidemic o f high virulent strains.By comparing the clinical information of patients in group CDI and non CDI,we found that coronary heart disease,renal failure,the 3 generation cephalosporin and the combined use of antibiotics were risk factors for C lostridium d ifficile infection,and no protective factors were found in C lostridium difficile infection.