基于QIAxcel的艰难梭菌核糖体分型和毒力谱鉴定
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动物源和人源的078型几乎是一个clonal，提示它们有 共同祖先；猪向人的传播是有可能的；有报道发现零售 猪肉有艰难梭菌，也间接证明了这一点
Author, year
No. isolates/
No. samples
No. hospitals
Dong, 2013
60/NG
1
Dong, 2014
94/NG
http://www.health.wa.gov.au/diseasewatch/vol17_issue4/clostridium.cfm
C. difficile in retail foods
Canada: 12.8% (26/203) of chicken meat 20% (12/60) of ground beef and veal meat 4.8% (5/119) of seafood and fish 4.5% (5/111) of vegetables
1.0 345
0
0
0
002,og 39,012
Tai Wan
0.4 68
0
0
0
NG
Shang Hai
0.9 50
25
0
1
017, 012, A
Zheng Jiang
NG 38
14
5
0
NG
Shang Hai
1.0 NG
NG
NG
NG
SH II, 014
Chang Sha
1.0
9
10
2
UN
017, 012, 046
*Dubberke ER, et al. Clin Infect Dis. 2007;45:1543-1549.
艰难梭菌流行规律变迁 艰难梭菌动物、食品感染
Changing epidemiology
Annual incidence per 100, 000 population of C. difficile-associated diarrheal in Quebec between 1991 to 2003 (Pepin, Valiquette et al. 2004)
1
Fang, 2014
82/400
3 cancer
Lam, 2012
10/32
1
Huang, 2009
74/587
1
Huang, 2014
65/206
1
Cheng, 2011
345/3528
1 HCF
Cheng, 1997
68/81
1 ICU
Huang, 2009
75/ NG
1 cancer
Zhu, பைடு நூலகம்014
基于QIAxcel的艰难梭菌核糖 体分型和毒力谱鉴定
淋病奈瑟式菌
生物特性
•革兰阳性杆菌，专性厌氧，人兽共患； •毛玻璃样，马粪味；芽胞，抵抗力强 •致病因子。
CDI临床表现
•无病症携带者 •轻度腹泻 •致命性伪膜性结肠炎（PMC），并发巨结肠和肠穿孔
易感人群
•长期广谱抗生素的使用者 •高龄，体弱者、免疫力低下者（肿瘤、HIV感染） •服用质子泵受体拮抗剂者 •长期住院治疗等
CDAD pressure =5 × days in unit
Unit A Fewer patients with active CDI
=lower risk of acquiring CDI
Unit B More patients with active CDI =higher risk of acquiring CDI
volume 13, July 2008
截止 2008年10月 : 美国有40个州报道核糖体 027 型病例
美国
http://www.cdc.gov/NCIDOD/DHQP/pdf/State _Map_NAP1_10_2008.pdf
加拿大
078型
最初主要是从猪和牛分离到的； 近来，成为引起人类CDI的重要型别，可产生严重的临 床表现和高致死率，尤其是引起社区人群的感染
57/ NG
1
Huang, 2008
56/587
1
Pete, 2013
21/70
1
#Cheng, 2009
12/112
1
Chia, 2013
110/ NG
1
Wei, 2013
57/149
6
Region
Time A+B+ A-B+
(y)
A-B-
cdt+
*PCR ribotype
Shang Hai
1.5 25
艰难梭菌感染 的世界分布
中国疾病预防控制中心
Chinese Center for Disease Control and Prevention
全球艰难梭菌的爆发流行
欧洲
多数欧洲国家都报道核糖体 027型感染病例
核糖体027型导致更高的病死率和 死亡率
Kuijper E., Barbut F., Eurosurveillance 2008, voKluumijpeer13E,.,JBulayrb2u0t08F., Eurosurveillance 2008,
Beijing
0.6
5
3
4
0
ZR1
Taiwan
6.0 70
40
0
4
NG
Taiwan
0.7 29
NG
NG
NG
10, 106, 45
C. difficile-Associated Disease Pressure* and Transmission
CDAD pressure =1 × days in unit
Community-associated C. difficile infection (CA-CDI) and hospital-associated C. difficile infection (HA-CDI) cases reported to Hospital Infection Surveillance Western Australia (HISWA), 2010 to 2012.
Texes: 9.5% (23/243) of pork sausages Arizona: 42% (74/176) of sausage, ground beef and pork Costa Rica: 2% (4/200) of retail meats
28
7
1
NG
Shang Hai
2.3 63
31
0
1
NG
Zhe Jiang
0.8 82
0
0
0
001, 017, 017/1
Hong Kong
0.1 NG
NG
NG
NG
002
Shang Hai
1.0 43
13
13
0
SH II
Shang Hai
1.0 NG
NG
NG
NG
H, 012, 017
Hong Kong
Author, year
No. isolates/
No. samples
No. hospitals
Dong, 2013
60/NG
1
Dong, 2014
94/NG
http://www.health.wa.gov.au/diseasewatch/vol17_issue4/clostridium.cfm
C. difficile in retail foods
Canada: 12.8% (26/203) of chicken meat 20% (12/60) of ground beef and veal meat 4.8% (5/119) of seafood and fish 4.5% (5/111) of vegetables
1.0 345
0
0
0
002,og 39,012
Tai Wan
0.4 68
0
0
0
NG
Shang Hai
0.9 50
25
0
1
017, 012, A
Zheng Jiang
NG 38
14
5
0
NG
Shang Hai
1.0 NG
NG
NG
NG
SH II, 014
Chang Sha
1.0
9
10
2
UN
017, 012, 046
*Dubberke ER, et al. Clin Infect Dis. 2007;45:1543-1549.
艰难梭菌流行规律变迁 艰难梭菌动物、食品感染
Changing epidemiology
Annual incidence per 100, 000 population of C. difficile-associated diarrheal in Quebec between 1991 to 2003 (Pepin, Valiquette et al. 2004)
1
Fang, 2014
82/400
3 cancer
Lam, 2012
10/32
1
Huang, 2009
74/587
1
Huang, 2014
65/206
1
Cheng, 2011
345/3528
1 HCF
Cheng, 1997
68/81
1 ICU
Huang, 2009
75/ NG
1 cancer
Zhu, பைடு நூலகம்014
基于QIAxcel的艰难梭菌核糖 体分型和毒力谱鉴定
淋病奈瑟式菌
生物特性
•革兰阳性杆菌，专性厌氧，人兽共患； •毛玻璃样，马粪味；芽胞，抵抗力强 •致病因子。
CDI临床表现
•无病症携带者 •轻度腹泻 •致命性伪膜性结肠炎（PMC），并发巨结肠和肠穿孔
易感人群
•长期广谱抗生素的使用者 •高龄，体弱者、免疫力低下者（肿瘤、HIV感染） •服用质子泵受体拮抗剂者 •长期住院治疗等
CDAD pressure =5 × days in unit
Unit A Fewer patients with active CDI
=lower risk of acquiring CDI
Unit B More patients with active CDI =higher risk of acquiring CDI
volume 13, July 2008
截止 2008年10月 : 美国有40个州报道核糖体 027 型病例
美国
http://www.cdc.gov/NCIDOD/DHQP/pdf/State _Map_NAP1_10_2008.pdf
加拿大
078型
最初主要是从猪和牛分离到的； 近来，成为引起人类CDI的重要型别，可产生严重的临 床表现和高致死率，尤其是引起社区人群的感染
57/ NG
1
Huang, 2008
56/587
1
Pete, 2013
21/70
1
#Cheng, 2009
12/112
1
Chia, 2013
110/ NG
1
Wei, 2013
57/149
6
Region
Time A+B+ A-B+
(y)
A-B-
cdt+
*PCR ribotype
Shang Hai
1.5 25
艰难梭菌感染 的世界分布
中国疾病预防控制中心
Chinese Center for Disease Control and Prevention
全球艰难梭菌的爆发流行
欧洲
多数欧洲国家都报道核糖体 027型感染病例
核糖体027型导致更高的病死率和 死亡率
Kuijper E., Barbut F., Eurosurveillance 2008, voKluumijpeer13E,.,JBulayrb2u0t08F., Eurosurveillance 2008,
Beijing
0.6
5
3
4
0
ZR1
Taiwan
6.0 70
40
0
4
NG
Taiwan
0.7 29
NG
NG
NG
10, 106, 45
C. difficile-Associated Disease Pressure* and Transmission
CDAD pressure =1 × days in unit
Community-associated C. difficile infection (CA-CDI) and hospital-associated C. difficile infection (HA-CDI) cases reported to Hospital Infection Surveillance Western Australia (HISWA), 2010 to 2012.
Texes: 9.5% (23/243) of pork sausages Arizona: 42% (74/176) of sausage, ground beef and pork Costa Rica: 2% (4/200) of retail meats
28
7
1
NG
Shang Hai
2.3 63
31
0
1
NG
Zhe Jiang
0.8 82
0
0
0
001, 017, 017/1
Hong Kong
0.1 NG
NG
NG
NG
002
Shang Hai
1.0 43
13
13
0
SH II
Shang Hai
1.0 NG
NG
NG
NG
H, 012, 017
Hong Kong