艰难梭菌与耐万古霉素肠球菌：新的医院内联盟。

Clostridium difficile and vancomycin-resistant enterococcus: the new nosocomial alliance.

作者信息

Poduval R D, Kamath R P, Corpuz M, Norkus E P, Pitchumoni C S

机构信息

Department of Medicine, Our Lady of Mercy Medical Center, Bronx, New York 10466, USA.

出版信息

Am J Gastroenterol. 2000 Dec;95(12):3513-5. doi: 10.1111/j.1572-0241.2000.03291.x.

DOI:10.1111/j.1572-0241.2000.03291.x

PMID:11151886

Abstract

OBJECTIVES

The aims of this study were to determine the frequency of the association between Clostridium difficile (C. difficile) and vancomycin-resistant Enterococcus (VRE) and delineate the role of C. difficile coinfection as a predictor of VRE infection versus colonization and adverse outcome.

METHODS

Patients with both C. difficile colitis and VRE (CD/VRE) were compared to patients with VRE alone with regard to demographics, comorbidity, prior antibiotic therapy, and coinfection with methicillin-resistant Staphylococcus aureus and funguria. C. difficile as a predictor of VRE infection (VRE-I) versus colonization (VRE-C) and adverse outcome was also studied.

RESULTS

Eighty-nine patients with VRE infection or colonization were studied. This included 31 cases of VRE-I and 58 VRE-C. C. difficile was isolated in 17 (19.1%) of patients; of these C. difficile was isolated before VRE in 9 patients and after VRE in 8. The two groups did not differ in age, residence, or comorbidity. C. difficile coinfection was not predictive of VRE-I versus VRE-C, nor was it associated with increased length of stay or mortality. However, the mortality rates in both groups was high, around 30%. A significant association was noted between the use of vancomycin and metronidazole (before the isolation of VRE) and C. difficile coinfection (p = 0.03 and p = 0.001, respectively). A high incidence of nosocomial coinfection with methicillin-resistant Staphylococcus aureus, funguria, and gram-negative sepsis was noted in both groups; the association with funguria was statistically significant (p = 0.029).

CONCLUSIONS

In conclusion, C. difficile coinfection is common in patients with VRE infection or colonization and is significantly associated with other nosocomial dilemmas like funguria. This may result in the emergence of highly virulent pathogens including vancomycin-resistant C. difficile, posing new challenges in the management of nosocomial diarrheas.

摘要

目的

本研究的目的是确定艰难梭菌（C. difficile）与耐万古霉素肠球菌（VRE）之间关联的频率，并阐明艰难梭菌合并感染作为VRE感染与定植以及不良结局预测指标的作用。

方法

将患有艰难梭菌结肠炎和VRE（CD/VRE）的患者与仅患有VRE的患者在人口统计学、合并症、既往抗生素治疗以及耐甲氧西林金黄色葡萄球菌和真菌尿合并感染方面进行比较。还研究了艰难梭菌作为VRE感染（VRE-I）与定植（VRE-C）以及不良结局预测指标的情况。

结果

对89例VRE感染或定植患者进行了研究。其中包括31例VRE-I和58例VRE-C。17例（19.1%）患者分离出艰难梭菌；其中9例患者在VRE之前分离出艰难梭菌，8例在VRE之后分离出。两组在年龄、居住情况或合并症方面无差异。艰难梭菌合并感染不是VRE-I与VRE-C的预测指标，也与住院时间延长或死亡率增加无关。然而，两组的死亡率都很高，约为30%。在使用万古霉素和甲硝唑（在VRE分离之前）与艰难梭菌合并感染之间存在显著关联（分别为p = 0.03和p = 0.001）。两组医院内耐甲氧西林金黄色葡萄球菌、真菌尿和革兰阴性菌败血症合并感染的发生率都很高；与真菌尿的关联具有统计学意义（p = 0.029）。