摘要目的：初步研究湘雅医院艰难梭菌临床分离株的病原学、毒素基因携带情况及核糖体分型情况，并对其临床特征进行分析，为临床提高艰难梭菌分离率以及采取积极有效的防控措施奠定基础。方法采用前瞻性研究，收集中南大学湘雅医院2012年6至12月腹泻患者粪便标本452份，对其进行选择性厌氧培养及API20A鉴定，并对阳性标本进行毒素基因检测（ tcdA、tcdB、cdtA、cdtB）和核糖体分型（16S-23S间隔区多态性）；收集所有患者临床资料，并对其进行Logistic回归分析筛选其发病高危因素。结果艰难梭菌检出率13.94％（63／452），其中42.86％（36／63）为 A－B＋型，14.29％（9／63）来自社区感染，二元毒素基因检测均为阴性；共检出11种核糖体型，其中CD017最常见，占22.22％（14／63）；Logistic回归分析显示，年龄＞55（ P＝0.016； OR＝4.45；95％CI：1.33～14.91），腹泻次数（P＝0.007；OR＝0.03；95％CI：0.002～0.38）及腹泻持续时间（P＝0.015； OR＝7.86；95％CI：1.50～41.16）为其发病高危因素。结论艰难梭菌是湘雅医院腹泻患者重要致病菌，主要来自医院感染，A－B＋型检出率较高；核糖体分型存在相对优势型别CD017，无证据提示存在艰难梭菌感染的暴发流行。

abstractsObjective A preliminary study on the etiology , the gene typing , the PCR-ribotyping and the clinical features of Clostridium difficile from clinical isolates at Xiangya Hospital could improve the isolation rate and provide the basis for effectively prevention of C.difficile.Methods A prospective observational study was performed.A total of 452 stool samples were collected during June to December 2012 at Xiangya Hospital.All stools were anaerobic cultured by selective medium and identified by API 20A for C.difficile.The positive isolates were detected the toxin genes ( tcdA, tcdB, cdtA, cdtB ) and ribotyping (16S-23S internal spacer region ) by PCR.The clinical data of all patients were collected and analyzed through Logistic regression to discover the risk factors for the development of C.difficile infection ( CDI ) . Results The rate of CDI occurrence was 13.94%(63/452), among them, 42.86%(36/63) were A-B+strains and only 14.29%(9/63) were obtained from community acquired-CDI.No binary toxin was detected in any of the isolates.Eleven different PCR ribotypes were identified , the dominant ribotype CD017 accounted for 22.22%(14/63).Logistic regression analysis showed that the risk factors for CDI included age>55(P=0.016;OR=4.45;95%CI:1.33-14.91), diarrhea frequency(P=0.007, OR=0.03;95%CI:0.002 -0.38 ) and the duration of diarrhea ( P =0.015; OR =7.86; 95%CI: 1.50 -41.16 ) . Conclusions C.difficile is the main pathogens of diarrhea patients and is mainly from hospital infections with higher detection rate of A -B+ in Xiangya Hospital.Ribotyping exist comparative advantages type CD017.No evidence suggests outbreak of C.difficile infection.