Morgan Oliver W, Rodrigues Boaventura, Elston Tony, Verlander Neville Q, Brown Derek F J, Brazier Jonathan, Reacher Mark
East of England Regional Epidemiology Unit, Health Protection Agency, Cambridge, United Kingdom.
PLoS One. 2008 Mar 19;3(3):e1812. doi: 10.1371/journal.pone.0001812.
Clostridium difficile is a leading infectious cause of health care associated diarrhoea. Several industrialised countries have reported increased C. difficile infections and outbreaks, which have been attributed to the emergent PCR ribotype 027 strain.
We conducted a case-case study to compare severity of C. difficile disease for patients with 027 versus non-027 ribotypes. We retrospectively collected clinical information about 123/136 patients with C. difficile infections admitted to hospitals in the East of England region in 2006 and from whom stool isolates were cultured and ribotyped as part of an earlier national survey. We defined severe C. difficile disease as having one or more of shock, paralytic ileus, pseudo membranous colitis or toxic megacolon. Patient median age was 83 years old (range 3 to 98, interquartile range 75 to 89), 86% were prescribed antibiotics in the eight weeks before illness onset, 41% had ribotype 027 and 30-day all cause mortality during hospital admission was 21%. Severe disease occurred in 24% (95%CI 13% to 37%) and 17% (95%CI 9% to 27%) of patients with PCR ribotype 027 and non-027 ribotypes respectively. In a multivariable model, ribotype 027 was not associated with severe disease after adjusting for sex, discharge from hospital prior to 60 days of current admission, gastroenteritis on admission, number of initiator antibiotics for C. difficile disease, and hospital where the patient was admitted.
Our study found no evidence to support previous assertions that ribotype 027 is more virulent than other PCR ribotypes. This finding raises questions about the contribution of this strain to the recent increase in C. difficile disease throughout North America and Europe.
艰难梭菌是医疗保健相关腹泻的主要感染病因。几个工业化国家报告了艰难梭菌感染及暴发的增加，这被归因于新出现的PCR核糖体分型027菌株。
我们进行了一项病例对照研究，以比较027核糖体分型与非027核糖体分型患者的艰难梭菌病严重程度。我们回顾性收集了2006年在英格兰东部地区医院住院的123/136例艰难梭菌感染患者的临床信息，这些患者的粪便分离株曾进行培养和核糖体分型，作为早期一项全国性调查的一部分。我们将严重艰难梭菌病定义为出现休克、麻痹性肠梗阻、假膜性结肠炎或中毒性巨结肠中的一种或多种。患者中位年龄为83岁（范围3至98岁，四分位间距75至89岁），86%在发病前八周内使用过抗生素，41%为核糖体分型027，住院期间30天全因死亡率为21%。PCR核糖体分型027和非027的患者中，严重疾病发生率分别为24%（95%CI 13%至37%）和17%（95%CI 9%至27%）。在多变量模型中，调整性别、本次入院前60天内出院、入院时的肠胃炎、艰难梭菌病起始抗生素数量以及患者入院的医院后，核糖体分型027与严重疾病无关。
我们的研究没有发现证据支持之前关于核糖体分型027比其他PCR核糖体分型更具毒性的说法。这一发现引发了关于该菌株对北美和欧洲近期艰难梭菌病增加所起作用的疑问。
