为了解上海地区住院人类免疫缺陷病毒(HIV)感染患者中艰难梭菌相关性腹泻(CDAD)的发生率、临床特征、药敏及分型情况，收集250例住院HIV感染腹泻患者的粪便，用选择性培养基进行艰难梭菌和一般肠道致病菌分离；用E­Test法测定艰难梭菌对甲硝唑、万古霉素、克林霉素、莫西沙星的敏感度；用多位点序列分型法(MLST)和聚合酶链反应(PCR)检测菌株基因类型及细菌毒素基因tcdA和tcdB。结果共检出29株(11.6%)艰难梭菌，均对甲硝唑、万古霉素敏感，对莫西沙星和克林霉素的耐药率分别为31.0%和69.0%。MLST分型共检出12种ST型别(ST­2、­3、­7、­8、­26、­35、­37、­38、­39、­54、­81和 ­124)，其中ST­54(6/29, 20.7%)和ST­39(5/29，17.2%)是主要流行亚型；毒素基因tcdA^＋/tcdB^＋ 17株(17/29, 58.6%)，毒素基因tcdA^－/tcdB^－ 12株(12/29，41.4%)，未检出毒素基因tcdA^－/tcdB^＋菌株。结果提示，上海地区住院HIV感染腹泻患者粪便标本中艰难梭菌的分离率较高，需严密监控以防暴发流行。

To investigate Clostridium ­difficile (C. difficile)­associated diarrhea (CDAD) in human immunodeficiency virus (HIV)­infected inpatients in Shanghai, C. difficile and general intestinal tract pathogenic bacteria were isolated by selective medium from abnormal fecal specimens collected from 250 HIV ­infected inpatients from March 2012 to March 2013. The susceptibilities of C. difficile to metronidazole, vancomycin, clindamycin and moxifloxacin were determined by E­-test method. Molecular typing was performed by multi­locus sequence typing (MLST). The genes tcdA and tcdB of toxins A and B were detected by conventional polymerase chain reaction (PCR). 29 clinical strains of C. difficile were isolated from 250 fecal specimens (11.6%), in which 17 strains were tcdA^＋/tcdB^＋ and 12 strains were tcdA^－/tcdB^－. All strains were susceptible to metronidazole and vancomycin. Resistance to clindamycin and moxifloxacin was found in 69.0% and 31.0% strains respectively. A total of 12 different sequence types (ST­2, ­3, ­7, ­8, ­26, ­35, ­37, ­38, ­39, ­54, ­81, and ­124) were identified. The most prevalent ST types were ST­54 (6/29, 20.7%) and ST­39 (5/29, 17.2%). The results suggest that the rate of positive C. difficile detection is high and should be monitored strictly to prevent outbreak.