Langley Joanne M, LeBlanc John C, Hanakowski Martha, Goloubeva Olga
Infect Control Hosp Epidemiol. 2002 Nov;23(11):660-4. doi: 10.1086/501990.
We report surveillance of nosocomial diarrhea in children at our institution during the past decade and note different epidemiology of diarrhea due to viruses and Clostridium difficile.
A prospective cohort study.
A university-affiliated pediatric hospital with 180 beds serving an urban area and providing referral care for the Maritime Provinces of Canada.
Children younger than 18 years.
Surveillance was conducted from 1991 to 1999 using personal contact with personnel and review of microbiology and medical records. Nosocomial diarrhea was defined as loose stools occurring more than 48 hours after admission, with at least two loose stools in 12 hours and no likely non-infectious cause.
Nosocomial diarrhea was the third most common nosocomial infection (217 of 1,466; 15%), after bloodstream and respiratory infections, with from 0.5 to 1 episode per 1,000 patient-days. Of 217 nosocomial diarrhea episodes, 122 (56%) had identified pathogens: C. difficile (39 of 122; 32%), rotavirus (38 of 122; 31%), adenovirus (36 of 122; 30%), and other viral (9 of 122; 7%). The median age was 1.3 years (range, 11 days to 17.9 years), 0.80 year for children with viral diarrhea, 3.9 years for children with C. difficile, and 1.5 years for children with diarrhea without a causative organism identified (P< .0001). Most children with nosocomial diarrhea were incontinent (diapered) at the time of their first episode (138 of 185; 75%), but preexisting incontinence was more common in those with viral diarrhea (93%) compared with those with no organism identified (71%) or those with C. difficile-associated diarrhea (CDAD) (49%) (P <.0001).
C. difficile is the single most common cause of nosocomial diarrhea in our tertiary-care center, although all viral pathogens account for 69% of cases. Diapered status appears to be a risk factor for CDAD in children, and CDAD occurs more often in older children than viral nosocomial diarrhea. Further characterization of risk factors for, and morbidity associated with, nosocomial CDAD in children is warranted.
我们报告了过去十年间在本机构对儿童医院获得性腹泻的监测情况，并指出了病毒和艰难梭菌所致腹泻的不同流行病学特征。
一项前瞻性队列研究。
一家隶属于大学的儿科医院，有180张床位，服务于市区，并为加拿大海洋省份提供转诊护理。
18岁以下儿童。
1991年至1999年进行监测，通过与工作人员个人联系以及查阅微生物学和医疗记录。医院获得性腹泻定义为入院48小时后出现的稀便，12小时内至少有两次稀便且无可能的非感染性病因。
医院获得性腹泻是第三常见的医院感染（1466例中有217例；15%），仅次于血流感染和呼吸道感染，每1000个患者日有0.5至1次发作。在217例医院获得性腹泻发作中，122例（56%）有明确的病原体：艰难梭菌（122例中的39例；32%）、轮状病毒（122例中的38例；31%）、腺病毒（122例中的36例；30%）和其他病毒（122例中的9例；7%）。中位年龄为1.3岁（范围：11天至17.9岁），病毒腹泻患儿为0.80岁，艰难梭菌感染患儿为3.9岁，未查明病原体的腹泻患儿为1.5岁（P<0.0001）。大多数医院获得性腹泻患儿首次发作时仍需使用尿布（185例中的138例；75%），但与未查明病原体的患儿（71%）或艰难梭菌相关性腹泻（CDAD）患儿（49%）相比，病毒腹泻患儿中既往使用尿布的情况更为常见（93%）（P<0.0001）。
在我们的三级护理中心，艰难梭菌是医院获得性腹泻最常见的单一病因，尽管所有病毒病原体占病例的69%。使用尿布状态似乎是儿童CDAD的一个危险因素，且CDAD在大龄儿童中比病毒性医院获得性腹泻更常见。有必要进一步明确儿童医院获得性CDAD的危险因素及其相关发病率。
