MMWR Morb Mortal Wkly Rep. 2008 Apr 4;57(13):340-3.
Clostridium difficile is a well-known cause of hospital-acquired infectious diarrhea and is associated with increased health-care costs, prolonged hospitalizations, and increased patient morbidity. Previous antimicrobial use, especially use of clindamycin or ciprofloxacin, is the primary risk factor for development of C. difficile-associated diarrhea (CDAD) because it disrupts normal bowel flora and promotes C. difficile overgrowth. Historically, CDAD has been associated with elderly hospital in-patients or long-term--care facility (LTCF) residents. Since 2000, a strain of C. difficile that has been identified as North American pulsed-field type 1 (NAP1) and produces an extra toxin (binary toxin) and increased amounts of toxins A and B has caused increased morbidity and mortality among hospitalized patients. During 2005, related strains caused severe disease in generally healthy persons in the community at a rate of 7.6 cases per 100,000 population, suggesting that traditional risk factors for C. difficile might not always be factors in development of community-associated CDAD (CA-CDAD). Cases of CA-CDAD are not nationally reportable, and population-based data at a statewide level have not been reported previously. In 2006, the Connecticut Department of Public Health (DPH) implemented a statewide surveillance system to assess the burden of CA-CDAD and to determine the descriptive epidemiology, trends, and risk factors for this disease. This report describes that surveillance system and summarizes results from the first year of surveillance. The findings indicated the presence of occasionally severe CDAD among healthy persons living in the community, including persons with no established risk factors for infection. Clinicians should consider a diagnosis of CA-CDAD in outpatients with severe diarrhea, even in the absence of established risk factors. In addition, continued surveillance is needed to determine trends in occurrence and whether more toxigenic strains are having an increasing impact in the community and in the hospital setting.
艰难梭菌是医院获得性感染性腹泻的常见病因，与医疗保健成本增加、住院时间延长以及患者发病率上升有关。既往使用抗菌药物，尤其是使用克林霉素或环丙沙星，是发生艰难梭菌相关性腹泻（CDAD）的主要危险因素，因为它会破坏正常肠道菌群并促使艰难梭菌过度生长。从历史上看，CDAD一直与老年住院患者或长期护理机构（LTCF）居民相关。自2000年以来，一种被鉴定为北美脉冲场型1（NAP1）的艰难梭菌菌株产生了一种额外毒素（二元毒素）以及毒素A和毒素B的量增加，导致住院患者的发病率和死亡率上升。2005年期间，相关菌株在社区中一般健康人群中引起严重疾病的发生率为每10万人7.6例，这表明艰难梭菌的传统危险因素可能并非总是社区相关性CDAD（CA - CDAD）发病的因素。CA - CDAD病例无需全国上报，此前尚未有全州范围基于人群的数据报告。2006年，康涅狄格州公共卫生部（DPH）实施了一项全州监测系统，以评估CA - CDAD的负担，并确定该疾病的描述性流行病学、趋势和危险因素。本报告描述了该监测系统并总结了第一年的监测结果。研究结果表明，在社区居住的健康人群中偶有严重的CDAD病例，包括没有既定感染危险因素的人群。临床医生应对严重腹泻的门诊患者考虑CA - CDAD的诊断，即使不存在既定的危险因素。此外，需要持续监测以确定发病趋势以及是否有更多产毒菌株在社区和医院环境中产生越来越大的影响。
