荷兰艰难梭菌聚合酶链反应核糖体分型027/毒素分型III的传播与流行病学

Spread and epidemiology of Clostridium difficile polymerase chain reaction ribotype 027/toxinotype III in The Netherlands.

作者信息

Goorhuis A, Van der Kooi T, Vaessen N, Dekker F W, Van den Berg R, Harmanus C, van den Hof S, Notermans D W, Kuijper E J

机构信息

Department of Microbiology, Leiden University Medical Center, Leiden, The Netherlands.

出版信息

Clin Infect Dis. 2007 Sep 15;45(6):695-703. doi: 10.1086/520984. Epub 2007 Aug 6.

DOI:10.1086/520984

PMID:17712752

Abstract

BACKGROUND

After reports of emerging outbreaks in Canada and the United States, Clostridium difficile-associated disease (CDAD) due to polymerase chain reaction ribotype 027 was detected in 2 medium-to-large hospitals in The Netherlands in 2005.

METHODS

National surveillance was initiated to investigate the spread and the epidemiology of CDAD. Microbiologists were asked to send strains recovered from patients with a severe course of CDAD or recovered when an increased incidence of CDAD was noted. A standardized questionnaire was used to collect demographic, clinical, and epidemiological patient data. Strains were characterized by polymerase chain reaction ribotyping, toxinotyping, the presence of toxin genes, and antimicrobial susceptibility.

RESULTS

During the period from February 2005 through November 2006, 1175 stool samples from 863 patients were sent from 50 health care facilities. Of these patients, 218 (25.3%) had CDAD due to ribotype 027, and 645 patients (74.7%) had CDAD due to other ribotypes, mainly 001 (17.8%) and 014 (7.2%). Polymerase chain reaction ribotype 027 was more frequently present in general hospitals than in academic hospitals (odds ratio [OR], 4.38; 95% confidence interval [CI], 1.60-12.0). Outbreaks of CDAD were observed in 10 hospitals and in 1 nursing home. Patients infected with ribotype 027 were significantly older (OR, 2.18; 95% CI, 1.43-3.33), and significantly more patients used fluoroquinolones (OR, 2.88; 95% CI, 1.01-8.20), compared with those who were infected with other ribotypes. Clear trends were observed for more severe diarrhea (OR, 1.99; 95% CI, 0.83-4.73), higher attributable mortality (6.3% vs. 1.2%; OR, 3.30; 95% CI, 0.41-26.4), and more recurrences (OR, 1.44; 95% CI, 0.94-2.20).

CONCLUSIONS

Ribotype 027 was found in 20 (18.3%) of 109 hospitals in The Netherlands, with a geographic concentration in the western and central parts of the country. The clinical syndrome in patients with CDAD differed on the basis of ribotype. Thus, early recognition of the ribotype has benefits.

摘要

背景

在加拿大和美国报告出现新的疫情后，2005年在荷兰的2家中型至大型医院检测到由聚合酶链反应核糖体分型027引起的艰难梭菌相关性疾病（CDAD）。

方法

启动全国监测以调查CDAD的传播和流行病学情况。微生物学家被要求送检从患有严重CDAD病程的患者中分离出的菌株，或在CDAD发病率增加时分离出的菌株。使用标准化问卷收集患者的人口统计学、临床和流行病学数据。通过聚合酶链反应核糖体分型、毒素分型、毒素基因的存在情况以及抗菌药物敏感性对菌株进行鉴定。

结果

在2005年2月至2006年11月期间，来自50家医疗机构的863名患者的1175份粪便样本被送检。在这些患者中，218例（25.3%）患有由核糖体分型027引起的CDAD，645例患者（74.7%）患有由其他核糖体分型引起的CDAD，主要是0０1型（17.8%）和014型（7.2%）。聚合酶链反应核糖体分型027在综合医院中比在学术医院中更常见（优势比[OR]，4.38；95%置信区间[CI]，1.60 - 12.0）。在10家医院和1家疗养院观察到CDAD疫情。与感染其他核糖体分型的患者相比，感染核糖体分型027的患者年龄显著更大（OR，2.18；95% CI，1.43 - 3.33）并且使用氟喹诺酮类药物的患者显著更多（OR，2.88；95% CI，1.01 - 8.20）。观察到明显的趋势，即腹泻更严重（OR，1.99；95% CI，0.83 - 4.73）、归因死亡率更高（6.3%对1.2%；OR，3.30；95% CI，0.41 - 26.4）以及复发更多（OR，1.44；95% CI，0.94 - 2.20）。