Fenner L, Frei R, Gregory M, Dangel M, Stranden A, Widmer A F
Microbiology Laboratory, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
Eur J Clin Microbiol Infect Dis. 2008 Dec;27(12):1201-7. doi: 10.1007/s10096-008-0564-9. Epub 2008 Jun 17.
A prospective study was conducted during a one-year period between 2006 and 2007 to describe the epidemiology of Clostridium difficile-associated disease (CDAD) at University Hospital Basel, Switzerland (UHBS) and to determine phenotypic and genotypic features of C. difficile strains isolated at the Microbiology Laboratory UHBS including strains from regional non-university hospitals. We prospectively identified 78 CDAD cases at UHBS with an incidence of 2.65/1,000 hospitalised patients or 2.3/10,000 patient-days. Sixteen patients (20.5%) were infected with clindamycin-resistant strains of PCR-ribotype 027 during an outbreak at the geriatric hospital. Among 124 single-patient isolates, 28 (22.6%) were resistant to moxifloxacin and 34 (27.4%) were resistant to clindamycin, but all remained susceptible to metronidazole and vancomycin. Of 102 toxigenic isolates, 19 (18.7%) had an 18-bp deletion in the tcdC gene, eight (7.8%) a 39-bp deletion, and one (1.0%) a 54-bp deletion. Genes for binary toxin were present in 27 (21.8%). PCR-ribotype 027 was associated with older age (median age 83.5 vs. 65.5 years, p < 0.0001) and longer duration of hospitalisation before onset of disease (median 15.5 vs. 9 days, p = 0.014) with a trend towards higher crude mortality, more severe disease, and previous use of macrolides compared to ribotype non-027. Overall, severe disease correlated with use of a nasogastric tube and surprisingly shorter duration of hospitalisation before onset of disease. Today, laboratory-based and epidemiological surveillance systems are required to monitor CDAD cases and emergence of new epidemic strains.
在2006年至2007年的一年时间里，开展了一项前瞻性研究，以描述瑞士巴塞尔大学医院（UHBS）艰难梭菌相关疾病（CDAD）的流行病学情况，并确定在UHBS微生物实验室分离出的艰难梭菌菌株的表型和基因型特征，其中包括来自当地非大学医院的菌株。我们前瞻性地在UHBS确定了78例CDAD病例，发病率为每1000名住院患者中有2.65例，或每10000患者日中有2.3例。在老年医院的一次暴发期间，16名患者（20.5%）感染了PCR核糖体分型027的克林霉素耐药菌株。在124株单患者分离株中，28株（22.6%）对莫西沙星耐药，34株（27.4%）对克林霉素耐药，但所有菌株对甲硝唑和万古霉素仍敏感。在102株产毒分离株中，19株（18.7%）的tcdC基因有18 bp缺失，8株（7.8%）有39 bp缺失，1株（1.0%）有54 bp缺失。二元毒素基因存在于27株（21.8%）中。PCR核糖体分型027与年龄较大（中位年龄83.5岁对65.5岁，p<0.0001）以及疾病发作前住院时间较长（中位15.5天对9天，p=0.014）相关，与非027核糖体分型相比，粗死亡率更高、疾病更严重以及既往使用大环内酯类药物的趋势更明显。总体而言，严重疾病与使用鼻胃管相关，且令人惊讶的是与疾病发作前住院时间较短相关。如今，需要基于实验室和流行病学的监测系统来监测CDAD病例和新流行菌株的出现。
