Marciniak Christina, Chen David, Stein Adam C, Semik Patrick E
Department of Physical Medicine & Rehabilitation, Northwestern University Feinberg Medical School, Chicago, IL, USA.
Arch Phys Med Rehabil. 2006 Aug;87(8):1086-90. doi: 10.1016/j.apmr.2006.03.020.
To assess the prevalence of intestinal colonization with Clostridium difficile (C. difficile) at admission to acute rehabilitation and to identify risk factors associated with colonization.
Case-control study.
Consecutive admissions to 2 rehabilitation units (spinal cord injury, brain injury and stroke).
Free-standing acute rehabilitation facility.
Rectal swabs for culture for C. difficile were obtained at admission and cytotoxin assay performed on all culture positive specimens. Rates of colonization with cytotoxic C. difficile were calculated. Charts were reviewed for medical and demographic factors that may have predisposed patients to colonization, and for possible symptoms at the time of admission.
Percentage of patients with culture and cytotoxin assay positive for C. difficile. Frequency of specific patient characteristics that could predispose to C. difficile colonization.
Of admission stool samples, 16.4% tested positive for C. difficile; none of these patients had been identified as colonized before admission. No patients were discordant for C. difficile positivity on culture and presence of a toxigenic strain. No medical or demographic factors were associated with increased risk of colonization, including age (t(52)=-.748, P=.458, not significant [NS]), diarrhea within 24 hours of admission (chi(1)(2) test=.001, P=.973 [NS]), or use of oral or intravenous antibiotics at admission (chi(1)(2) test=.044, P=.834 [NS]).
Patients admitted to acute rehabilitation may have an elevated rate of intestinal colonization with C. difficile without having clinical symptoms. No medical or demographic characteristics were found to be predictive of colonization, however, most of the patients admitted had more than 1 factor that may have increased their susceptibility to infection with this organism. Inadvertent transfer of this organism within the rehabilitation setting may occur because asymptomatic colonization is not recognized.
评估急性康复入院时艰难梭菌肠道定植的患病率，并确定与定植相关的危险因素。
病例对照研究。
连续入住2个康复单元（脊髓损伤、脑损伤和中风患者）的患者。
独立的急性康复设施。
入院时采集直肠拭子进行艰难梭菌培养，并对所有培养阳性标本进行细胞毒素检测。计算产细胞毒素艰难梭菌的定植率。查阅病历以了解可能使患者易发生定植的医学和人口统计学因素，以及入院时可能出现的症状。
艰难梭菌培养和细胞毒素检测呈阳性的患者百分比。可能易发生艰难梭菌定植的特定患者特征的频率。
入院粪便样本中，16.4%的艰难梭菌检测呈阳性；这些患者在入院前均未被确定为定植。在培养结果和产毒菌株存在方面，没有患者的艰难梭菌阳性结果不一致。没有医学或人口统计学因素与定植风险增加相关，包括年龄（t(52)= -0.748，P = 0.458，无显著性差异[NS]）、入院后24小时内腹泻（卡方检验= 0.001，P = 0.973[NS]）或入院时使用口服或静脉抗生素（卡方检验= 0.044，P = 0.834[NS]）。
入住急性康复机构的患者可能艰难梭菌肠道定植率升高但无临床症状。未发现医学或人口统计学特征可预测定植，然而，大多数入院患者有超过1个可能增加其对该病原体感染易感性的因素。由于无症状定植未被识别，该病原体可能在康复环境中意外传播。
