Abstract:

ObjectiveTo investigate the effect of bundle management on preventing pulmonary infection(PI) in patients after liver transplantation, and reduce the incidence of PI.MethodsPatients who underwent liver transplantation in the department of hepatobiliary surgery of a hospital between January 2016 and December 2017 were selected as studied subjects. Patients who underwent liver transplantation between January 2016 and March 2017 were in control group, they were given routine nursing measures, and patients who underwent liver transplantation in AprilDecember 2017 were in trial group, they were given bundle management. Incidences of PI and atelectasis, first ambulation time, hospitalization cost, and patients’ satisfaction were compared between two groups.ResultsThere were 110 patients in control group and 67 in trial group with liver transplantation. Two groups of patients all successfully completed surgery. Incidence of PI in trial group was lower than control group (6.0% vs 16.4%, P<0.05). Incidence of atelectasis in trial group was lower than control group (7.5% vs 18.2%, P<0.05). The first ambulation time in trial group was shorter than control group（［83.81±7.56］ h vs ［91.67±13.93］ h, P<0.01). Length of hospital stay in trial group was shorter than control group（［30.22±3.23］ d vs ［31.49±4.34］ d，P<0.05). The total rate of patients’ satisfaction for nursing in trial group was higher than control group (92.5% vs 78.2%, P<0.05).ConclusionBundle management can effectively reduce the incidences of PI and atelectasis, shorten the first ambulation time and length of hospital stay, and improve patients’ satisfaction.

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ObjectiveTo evaluate variation of three key regions of HBV genome in patients with coinfection of hepatitis B virus (HBV) and human immunodeficiency virus type 1 (HIV1) as well as those only infected with HBV.MethodsForty serum specimens from patients with coinfection of HIV1/HBV(trial group) as well as 40 serum specimens from those only infected with HBV(control group) in Hunan Province were collected, the wholegenome of HBV was amplified and sequenced, the mutation sites were analyzed.ResultsHBV in serum of 59 cases were successfully genotyped and sequenced, 21 of which were from trial group and 38 from control group, there was significant difference in HBV load and genotype between trial group and control group (both P<0.05). In trial group, 4 patients were detected 22 amino acid mutations in the preS region of HBV in serum specimen, 12 were detected 45 nucleotide mutations in preC and basic core promoter (BCP) regions, the overall deletion mutation rates of amino acid in preS region of trial group and control group were 0.60% and 0.64% respectively, with no significant difference (χ2=0.042, P>0.05). There were no significant difference in mutations in key sites of preC and BCP regions between trial group and control group (both P>0.05), the overall variation rates in preC and BCP regions of trial group and control group were 1.36% and 1.73% respectively, difference was not significant (χ2=1.920, P>0.05).ConclusionHBV mutation in coinfected patients is basically the same as that in singleinfected patients, HIV1 has not obvious affect on the evolution of HBV mutation during a short time.

Abstract:ObjectiveTo understand the infection and antimicrobial resistance of Streptococcus agalactiae(S. agalactiae) isolated from genital tract of pregnant women in an area, and provide basis for clinical diagnosis and treatment.MethodsGenital tract secretion culture results of pregnant women in the obstetric wards and outpatient department of Guangdong General Hospital from January 2011 to December 2017 were collected, prevalence and changing trend of antimicrobial resistance of S. agalactiae in different years were compared and analyzed.ResultsA total of 31 569 genital tract specimens were detected, 1 940 strains of pathogens were isolated, 591 of which were S. agalactiae, accounting for 30.46%. Isolation rate of S. agalactiae in genital tract specimens was 1.87%; antimicrobial susceptibility testing results of S. agalactiae from 2011 to 2017 showed that no strains were resistant to penicillin, ampicillin, quinupristin/dalfopristin, linezolid, teicoplanin, and vancomycin; resistance rates of S. agalactiae to ciprofloxacin, levofloxacin, clindamycin, and erythromycin were 19.80%-28.97%, 19.80%-28.95%, 26.73%-39.29%, and 44.05%-66.34% respectively; resistance rate of S. agalactiae to tetracycline was the highest (80.37%-94.29%), but with a decreasing trend year by year (P<0.05).ConclusionS. agalactiae is the main pathogen of genital tract infection in pregnant women, analysis of antimicrobial resistance and rational use of antimicrobial agents can reduce the occurrence of S. agalactiae infection in pregnant women and newborns

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ObjectiveTo evaluate the effect of antimicrobial stewardship program (ASP) on perioperative antimicrobial selection and incidence of postoperative infection in patients undergoing thoracic surgery.MethodsFrom 2015 to 2016, patients who underwent lung or esophageal surgery in the department of thoracic surgery of a hospital and without infection before operation were selected. Patients in 2015 were in control group (before intervention), and patients in 2016 were in trial group (after intervention). ASP was performed in 2016, clinical pharmacists and doctors in infectious department standardized antimicrobial use through conducting realtime intervention in doctors’ orders for the use of carbapenems and fluoroquinolones. Standardized antimicrobial use and occurrence of surgical site infection(SSI) before and after the implementation of ASP were compared.ResultsBefore and after intervention, 953 and 1 061 patients were enrolled respectively. Incidence of SSI in patients undergoing esophageal and lung surgery before and after intervention were 1.57% and 1.70% respectively, with no significant difference (χ2=0.047, P=0.829). The rate of recommended use of antimicrobial agents (cefuroxime or cefmetazole) for preventing SSI rose from 37.15% (354/953) before intervention to 69.75% (740/1 061) after intervention, with a statistically significant difference before and after intervention (χ2=215.025, P=0.000). Comparison in AUD of antimicrobial agents in thoracic surgery before and after intervention showed that AUD of ertapenem decreased by 52.46% (8.12 VS 3.86), cefuroxime and cefmetazole increased by 98.00%(7.49 VS 14.83) and 95.18%(4.98 VS 9.72) respectively; ceftriaxone decreased by 85.29% (12.03 VS 1.77).ConclusionThe implementation of ASP reduced the usage of ertapenem and ceftriaxone, standardized preventive medication in thoracic surgery, and didn’t cause changes in the incidence of SSI in lung and esophageal surgery.

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ObjectiveTo evaluate the indirect economic burden of patients with severe healthcareassociated pneumonia (SHAP) in a tertiary firstclass specialty hospital through combined application of disabilityadjusted life year (DALY) and human capital method.MethodsAccording to DALY calculating method in the study of Global Burden of Disease (GBD), DALY of SHAP patients of each age group in a tertiary firstclass hospital from January 1, 2016 to December 31, 2017 was calculated, the indirect economic burden of SHAP patients was estimated by combining DALY with human capital method, patients were divided into two groups according to whether pathogens were multidrugresistant organisms (MDROs), indirect economic burden of two groups of patients was compared.ResultsAmong 71 SHAP patients, loss of DALY was 172.35 years, the average disease burden was 2.43 DALY, the average indirect economic burden was 51 428.37 Yuan. The average disease burden in SHAP patients in MDRO infection group (n=46 cases) and nonMDRO infection group (n=25 cases) were 3.36 and 0.71 DALY respectively, the average indirect economic burden were 77 235.32 and 3 957.18 Yuan respectively; difference in indirect economic burden between two groups of patients was statistically significant (P<0.05).ConclusionThe average disease burden and indirect economic burden of SHAP patients are not low, and indirect economic burden in SHAP patients with MDRO infection is higher than those with nonMDRO infection.

Abstract:

ObjectiveTo explore the related protein mediating Acinetobacter baumannii (AB) bloodstream infection(BSI), provide a new research direction for AB bloodstream infection(BSI).MethodsAB strains with the identical multilocus sequence typing (MLST) but isolated from different sites were retrieved from AB gene database, related differential protein which only existed in AB of BSI were analyzed by bioinformatics, and functional annotation analysis was conducted.ResultsUnder the established retrieval conditions, a total of 10 strains of AB were retrieved and divided into three groups according to MLST, including 4 strains of ST92 (2 strains from blood, and 2 from sputum), 4 strains of ST137 (2 from blood, and 2 from sputum), and 2 strains of ST365 (1 from blood, and 1 from sputum). Gene and protein database analysis results showed that partial protein only existed in AB of BSI, didn’t exist in AB isolated from sputum, there were 20, 4, and 22 specific protein in AB causing ST92, ST137, and ST365 BSI, respectively. The biological process in which specific protein involved was mainly concentrated on bacterial virulence and invasiveness, bacterial metabolism, DNA synthesis, DNA damage and repair, transcription, translation, gene translocation, and phagerelated protein.ConclusionBecause of individual difference, AB of the same MLST expressing the above differential protein may be the cause of BSI.

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ObjectiveTo evaluate the correlation between level of specific IgM antibody of nucleocapsid protein (N protein) and severity of severe fever with thrombocytopenia syndrome (SFTS).MethodsClinical characteristics and laboratory detection results of 30 patients with SFTS in a tertiary firstclass hospital were analyzed retrospectively, clinical characteristics and prognosis between patients in N protein specific IgM(+) group and N protein specific IgM(-) group was compared; patients were divided into mild disease group and severe disease group according to the severity of disease, correlation between IgM antibody titer and RNA load of SFTS virus (SFTSV) in patients in mild disease group and severe disease group was compared; correlation between N protein specific IgM antibody titer, SFTSVRNA load, and severity of disease in patients were analyzed.ResultsThe numbers of patients with neurological symptoms, death, and serious disease in N protein specific IgM(-) group were significantly higher than IgM(+) group (all P<0.05); N protein specific IgM antibody level was negatively correlated with SFTSVRNA load, prothrombin time (PT), lactate dehydrogenase (LDH), and aspartate aminotransferase (AST) (r=-0.495, -0.440, -0.367, -0.280, respectively, all P<0.05); while was positively correlated with platelets (PLT) (r=0.335, P=0.002). SFTSVRNA load was positively correlated with PT, LDH, and AST (r=0.606, 0.604, 0.587, respectively, all P<0.001); while was negatively correlated with PLT（r=-0.384，P＜0.001）. On the 10-13 day of onset, the titer of N protein specific IgM antibody in patients in mild disease group was higher than that in patients in severe disease group (P<0.05).ConclusionThe presence and increase of N protein specific IgM antibody are helpful for clearance of SFTSV, and has a repairing effect on damage of coagulation function, liver and myocardial damage; N protein specific IgM antibody may be an important factor for predicting prognosis of patients.

Abstract:ObjectiveTo explore the characteristics of adverse drug reaction (ADR) of secondline antituberculosis(TB) drugs.MethodsCase history of patients with ADR due to use of secondline antiTB drugs was selected from the ADR report summary table of a hospital in 2017, the occurrence of ADR, types of ADR, patients’ organ systems involved in ADR and the main clinical manifestations as well as prognostic data were analyzed.ResultsOf 121 patients with ADR due to secondline antiTB drugs, 59.50% (n=72) were males, 57.85%(n=70) were aged more than 60 years. The main dosage which inducing ADR is injection type(n=80, 66.12%), the main drugs were moxifloxacin (n=38, 31.40%) and levofloxacin (n=29, 23.96%). The main organ system involved in ADR was systemic (69/128, 53.91%), followed by central and peripheral nervous system (22/128, 17.19%). 9 patients（7.44%） were with severe ADR, 118 patients（97.52%）were recovered and improved.ConclusionADR due to use of secondline antiTB drugs often occurs in elderly patients, the main damage are systemic and peripheral nervous system damage due to use of quinolones. In the course of diagnosis and treatment, the highrisk population and the main therapeutic drugs should be monitored and performed active intervention, and the corresponding measures should be taken

Abstract:

ObjectiveTo understand healthcareassociated infection(HAI) rate and hand hygiene compliance rate in a hospital during Joint Commission International(JCI) accreditation stage, and evaluate the implementation efficacy of HAI control measures based on JCI accreditation standards.MethodsThree groups were divided according to preimplementation (preaccreditation), initiation (periaccreditation), and postaccreditation (postaccreditation) of JCI standards, difference in hand hygiene compliance rate, HAI rate, and consumption of hand hygiene products among health care workers(HCWs) at different stages were compared.ResultsCompliance rate of hand hygiene among all HCWs increased from 74.99% before JCI accreditation to 78.61% during periaccreditation period, and then to 90.95% after the accreditation, the overall difference was statistically significant (P<0.001). After JCI accreditation, consumption of hand sanitizer and alcoholbased hand rub increased in all wards of the hospital, HAI rates in departments of cardiology and oncologyhematology as well as the whole hospital decreased (P<0.05), and HAI rates also showed a downward trend (P<0.05). Compliance rate of HCWs’ hand hygiene was negatively correlated with HAI rate (r=-0.99, P<0.05).ConclusionAccording to JCI accreditation standards, realtime improvement can effectively improve hand hygiene compliance rate of HCWs and reduce HAI rate.

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ObjectiveTo investigate the changes in perforin (PRF) and granzyme B (GrzB) of CD8+ T cells and NK cells in children with handfootandmouth disease (HFMD) caused by enterovirus 71 (EV71).Methods30 children with common HFMD(common group), 30 with severe HFMD (severe group), and 30 healthy children volunteers (control group) in a hospital in MayJuly 2017 were selected, expression levels of PRF and GrzB in CD8+ T cells and NK cells in peripheral blood were detected by flow cytometry, differences among three groups were compared.ResultsCompared with control group, expression levels of PRF and GrzB in two kinds of cells of children with common and severe EV71 HFMD at acute stage were significantly higher, difference were both significant (both P<0.05). Expression levels of PRF and GrzB in CD8+ T cells of children with common and severe EV71 HFMD at convalescent stage were significantly lower than those at acute stage, but still higher than those in control group (both P<0.05). Expression levels of PRF and GrzB in NK cells: there was no significant difference between common group and severe group at acute stage (both P>0.05); compared with acute stage, at convalescent stage of common EV71 HFMD slightly increased, but difference was not statistically significant（both P>0.05）； at convalescent stage of severe EV71 HFMD were significantly higher than that in the acute stage (both P<0.05).ConclusionPerforin and granzyme B in CD8+ T cells and NK cells play a role in the pathogenesis of EV71 HFMD.

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ObjectiveTo summarize the clinical characteristics of infectious aneurysms caused by Burkholderia pseudomallei (B. pseudomallei), provide evidence for the diagnosis and treatment of the disease,  and reduce the misdiagnosis rate and mortality.MethodsThree cases of infectious aneurysms caused by B. pseudomallei and confirmed in Hainan General Hospital from January 2013 to December 2017 were collected, case reports of infectious aneurysms caused by B. pseudomallei at home and abroad from 1990 to 2017 were retrieved, clinical characteristics of all above cases were retrospectively analyzed.ResultsA total of 23 patients were enrolled, male patients accounted for 95.7%, with an average age of （62.2±5.8） years, hypertension and diabetes were the main complications, both accounting for 39.1%, abdominal aorta (65.2%) was the main lesion segment of aneurysm, followed by thoracic aorta (17.4%) and aortic arch (13.0%), 21 patients (91.3%) underwent surgical treatment, with a mortality of 21.7%.ConclusionMortality of infectious aneurysms caused by B. pseudomallei is high, middleaged and elderly men with hypertension and diabetes are at high risk, the main lesion segment is abdominal aorta. Early empiric antiinfective treatment should be paid attention to B. pseudomallei, once diagnosed, surgical treatment should be performed on the basis of active antiinfective treatment.

Abstract:

ObjectiveTo summarize the clinical characteristics and treatment outcome of postoperative infection of knee joint ankylosis surgery caused by Finegoldia magna(F. magna).MethodsClinical data of one case of infection with F. magna after knee joint ankylosis surgery was analyzed retrospectively, relevant literatures at home and abroad were reviewed and analyzed.ResultsThe incisional wound didn’t heal after knee ankylosis surgery, anaerobic culture result of exudate was F. magna, after 4 weeks of treatment with susceptible antimicrobials cefoxitin and penicillin sodium, the incisional wound was dry and without exudation, patient healed well and was discharged from hospital.ConclusionClinical significance of anaerobic bacterial infection should be fully recognized, in bone and joint infection, especially when the common bacterial culture result is negative, the possibility of infection with anaerobic bacteria should be considered.

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ObjectiveTo report the epidemiological investigation process as well as prevention and control measures for a suspected outbreak of healthcareassociated bloodstream infection(HAIBSI).MethodsAn epidemiological investigation on a suspected outbreak of HAIBSI in a hospital was carried out by means of clinical data investigation and onsite sampling, sources and transmission routes were determined, efficacy of prevention and control was evaluated.ResultsFrom April 21 to 28, 2014, a total of 6 patients in the neurological wards of a hospital suffered from chill and high fever, 4 cases were positive for peripheral blood culture (2 strains were Klebsiella pneumoniae, 1 strain was Acinetobacter baumannii and 1 strain was Enterobacter cloacae), HAIBSI was diagnosed. A total of 170 specimens were collected, the qualified rate of specimen detection result during centralized outbreak sampling period was lower than that after taking comprehensive prevention and control measures (64.91%［37/57］ VS 93.81%［106/113］, χ2=23.675，P=0.000）. Pathogens were mainly found in the area where most frequently touched by hands, bacteria on object surface in the vicinity of patients as well as bacteria on hands of caregivers were consistent with the pathogens causing  infection in patients. After comprehensive intervention was taken, no new case occurred, and 6 patients all recovered after treatment.ConclusionThis event is a suspected outbreak of HAIBSI, environmental contamination in wards and transmission through hands are the main sources and transmission routes. The implementation of targeted prevention and control measures of environmental decontamination and hand hygiene management can effectively control the outbreak of HAI.

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ObjectiveTo apply the receiver operating characteristic(ROC) curve to evaluate the predictive value of CD4+ T lymphocyte, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and platelet (PLT) in the prognosis of patients with acquired immunodeficiency syndrome(AIDS) and Talaromycosis marneffei (TSM）.MethodsA retrospective study was conducted on patients with AIDSassociated TSM in Liuzhou General Hospital from January 2013 to June 2015, patients were divided into improved group and deteriorated group according to prognosis, value of CD4+ T lymphocyte, ALT, AST and PLT in predicting the prognosis of patients were evaluated by ROC curve.ResultsA total of 96 cases of AIDS combined with TSM were initially treated, including 54 cases in improved group and 42 in deteriorated group. Serum ALT level in improved group was lower than that in deteriorated group (26.5［7.0, 148.0］ U/L VS 47.5［11.0, 116.0］ U/L). Serum AST level in improved group was lower than that in deteriorated group (49.0［10.0, 198.0］U/L VS 188.0［33.0, 435.0］ U/L). Plasma PLT level in improved group was higher than that in deteriorated group (133.0［13.0, 303.0］ ×109/L VS 33.5［7.0, 113.0］ ×109/L), CD4+ T lymphocyte level in improved group was higher than that in deteriorated group (24.0［5.0, 112.0］/μL VS 14.5［2.0,78.0］/μL), difference were all significant ( all P<0.05). ROC curve analysis showed that when AST≥2×ULN combined with PLT≤62×109/L, the area under curve (AUC) to predict the prognosis of TSM patients was 0.917 (95% CI: 0.835-0.998, P<0.05), sensitivity, specificity, positive predictive value, and negative predictive value were 90.0%, 93.3%, 93.1%, and 90.3%, respectively.ConclusionAST and PLT can be used as important prognostic indicators for prognosis of patients with AIDS and TSM, when AST≥2×ULN and PLT≤62×109/L, possibility of poor prognosis in TSM patients needs to be paid attention.

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ObjectiveTo understand the risk factors for methicillinresistant Staphylococcus aureus (MRSA) infection in intensive care unit(ICU) patients. Methods825 ICU patients in a tertiary general hospital from 2014 to 2016 were selected, a casecontrol study was conducted, patients infected with MRSA 48 hours after ICU admission were in case group, and those without MRSA infection 48 hours after ICU admission were in control group, univariate and multivariate logistic analysis were conducted.ResultsAmong 825 patients, 64(7.76%) had MRSA infection. The major MRSA infection was pulmonary infection(45.31%), followed by skin and soft tissue infection (18.75%), surgical site infection(9.38%), bloodstream infection (9.38%), intracranial infection(6.25%）, abdominal infection (6.25%), and thoracic infection (4.68%). Multivariate logistic regression analysis showed that independent risk factors for MRSA infection in ICU patients were surgery within a month （OR95%CI：2.628-9.166）, trauma (OR95%CI：2.248-9.280）, duration of tracheal intubation>7 days (OR95%CI：1.651-11.746), coma (OR95%CI：1.813-8.334）, longterm bedridden (OR95%CI：1.362-10.127）, readmission to ICU (OR95%CI：1.475-7.915）, parenteral nutrition (OR95%CI：1.521-7.518）, use two or more antimicrobial agents (OR95%CI：1.523-6.132）, and multiple organ failure (OR95%CI：1.024-3.948）(all P<0.05).ConclusionPrevention and control of MRSA in highrisk patients such as tracheal intubation, multiple organ failure, coma, longterm bedridden, and trauma should be paid attention, patients should be transferred out of ICU as soon as possible if their condition is permitted.

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ObjectiveTo monitor hand hygiene(HH) compliance of health care workers(HCWs) with a new method, compare the advantage and disadvantage with direct observation method.MethodsFrom July to December 2016, HH compliance of HCWs in intensive care unit (ICU) of a tertiary hospital was monitored simultaneously by HH electronic monitoring system and traditional direct observation method, results of two monitoring methods were compared. ResultsICU was observed for 7 days (42 hours), 2 231 HH opportunities were recorded, a total of 4 532 HH opportunities in 7 days were estimated, total bedday was 23 days, the average HH opportunities required for HCWs in ICU was 197 times/bedday. From July to December 2016, HH compliance rate monitored by electronic monitoring system was 54.16% on average, which was lower than 77.72% of direct observation method （χ2=50.53，P<0.001）. Cost of HH electronic monitoring system per hour (4.56 Yuan) was lower than that of direct observation method (20.78 Yuan).ConclusionCompared with traditional direct observation method, HH electronic monitoring system is more timesaving and laborsaving, data are more accurate and objective, and has a certain cost advantage in the economically developed regions.

Abstract:

肠道菌群是公认的细菌库，是多器官功能障碍综合征（MODS）的“发动机”。在人体内环境紊乱时，细菌暴发性增殖，其内毒素增加肠系膜血管床通透性，导致肠道组织水肿，屏障功能受损，引起脓毒血症和全身性炎症反应（SIRS），加剧急性肾损伤（AKI）及弥散性血管内凝血（DIC）等；肠道细菌产生的炎症因子还能通过肠系膜淋巴管道导致急性呼吸窘迫综合症（ARDS）、肝衰竭及肝性脑病［1］。肠道菌群紊乱的危害性推动了选择性消化道去污染及选择口咽去污染（SDD/SOD）的研究。多年来SDD/SOD始终是危重症领域探讨的话题，但因存在细菌对抗菌药物耐药的顾虑，目前SDD/SOD地位尴尬，其普及率较低。欧洲的重症监护病房（ICU）中SDD/SOD普及率仅17%，集中于荷兰和德国［23］，英国普及率仅5%，国内缺乏相关数据。大量临床研究源自耐药菌不太流行的荷兰，尽管有荟萃分析指出该地区结果与其他区域结果相似［4］，但其结果是否适用于耐药菌泛滥的中国，还需要更多研究证实。

Abstract:

艰难梭菌是一种革兰阳性厌氧芽孢杆菌。近年来由于高产毒株027/NAP1/BI型艰难梭菌在欧美地区的暴发流行，艰难梭菌感染（Clostridium difficile infection, CDI）的严重程度和发病率急剧上升［1］。在美国，艰难梭菌已经取代耐甲氧西林金黄色葡萄球菌（methicillinresistant Staphylococcus aureu, MRSA）成为医院感染的首要病原菌，因此其将艰难梭菌的威胁等级定为最高“紧急”级别。CDI的临床表现可从无症状定植到轻度自限性腹泻或重度假膜性肠炎甚至危及生命。其临床症状的发生发展主要取决于两个方面，一是艰难梭菌的毒力，二是宿主肠道微生物群及免疫反应。毒素是艰难梭菌最主要的毒力因子，包括毒素A（TcdA）和毒素B（TcdB），两者均能灭活GTP结合蛋白，引发一系列反应最终导致腹泻和肠炎［23］。此外，某些特殊型别的菌株如027/NAP1/BI还能产生二元毒素，与CDI的高发病率和病死率相关［4］。黏附是艰难梭菌另一项重要的毒力因素，参与黏附的物质有很多，如艰难梭菌表面蛋白、鞭毛等均可参与细菌黏附过程［58］。不管是毒素还是细菌表面成分均可引起免疫反应，如炎性介质释放、免疫效应细胞趋化等。肠道微生物群在CDI过程中也是至关重要的，一旦微生物群平衡被破坏，便可促进肠道内艰难梭菌芽孢的萌发、生长、繁殖、定植、产毒。目前，在中国和其他许多亚洲国家，CDI尚未引发暴发流行，但人们对CDI的重视程度不够，国内关于CDI的研究数据非常有限。因此，本文就艰难梭菌的致病过程及肠道微生物群和免疫反应在CDI发生发展过程中的作用作以综述。

Abstract:

肠道感染性疾病重要病原菌，如志贺菌和沙门菌等感染发病率高、传播速度快、耐药发生率也高［12］。据文献报道，肝硬化［3］、HIV感染［4］、炎症性肠道病［5］以及血糖调节［6］等均与肠道菌群失调有关。此外，引起胃肠道感染的食源性致病菌是食品安全的严重隐患［7］，可引起胃肠炎、败血症等疾病。因此，快速检测威胁人类健康的病原菌刻不容缓。目前，临床常规的病原菌检测技术多采用传统细菌培养并进行生化反应及血清学鉴定等，耗时繁琐，检测灵敏度低，且检测技术人员的操作水平和经验也对检测结果的准确性有重要影响［8］。研发灵敏度高、特异性强的检测技术进行病原菌的快速检测，在疾病预防以及临床诊断、指导用药等方面具有重要意义。1985年美国Kary mullis首次提出聚合酶链式反应（polymerase chain reaction, PCR）技术，该技术因其高效、灵活以及快速等特点被广泛应用。由于传统PCR技术存在一定缺陷，为弥补该检测方法的不足，一系列基于PCR原理的新型检测技术不断研发，为肠道病原菌的鉴定提供了有效的指导与技术支持。本文就基于PCR技术原理的肠道病原菌检测技术进行归纳综述，并分析比较各类方法的优缺点。