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目的调查胃肠外科病区分离艰难梭菌毒素基因情况及耐药性,为治疗提供依据。方法采集衢州市中心医院235例腹泻患者粪便标本,进行选择性厌氧培养及鉴定,并对艰难梭菌阳性标本进行毒力基因检测,采用E-test检测药物敏感性。结果艰难梭菌检出率为8.51%(20/235),其中11株为A-B+型,5株为A+B+型,4株为A-B-型;未检出二元毒素(cdt A、cdt B)。所有菌株对甲硝唑和万古霉素均敏感,对克林霉素、美罗培南、红霉素和左氧氟沙星的敏感度分别为80%、15%、80%和25%。16株对克林霉素耐药的艰难梭菌中,erm B阳性菌株检出率为81.25%(13/16)。结论本院胃肠外科病区流行的艰难梭菌产毒株以A-B+型菌株为主,其对克林霉素、红霉素耐药严重,甲硝唑和万古霉素可作为艰难梭菌相关腹泻的治疗首选药物。
Objective To investigate the isolation and drug resistance of Clostridium difficile toxin gene in gastrointestinal surgery and provide basis for treatment. Methods A total of 235 diarrhea patients in Quzhou Central Hospital were collected for selective anaerobic culture and identification. Virulence genes were also detected in C. difficile positive samples. The drug sensitivity was detected by E-test. Results The positive rate of Clostridium difficile was 8.51% (20/235), of which 11 were A-B +, 5 were A + B + and 4 were AB-type. No binary toxin (cdt A, cdt B). All strains were sensitive to metronidazole and vancomycin, and their sensitivity to clindamycin, meropenem, erythromycin and levofloxacin were 80%, 15%, 80% and 25%, respectively. Among 16 strains of Clindamycin-resistant C. difficile, the positive rate of erm B was 81.25% (13/16). Conclusions A to B + type strains are predominant strains of C. difficile in our department of gastrointestinal surgery. They are resistant to clindamycin and erythromycin. Metronidazole and vancomycin can be used as difficult shuttle The treatment of bacteria-related diarrhea preferred drug.