Leal J, Gregson D B, Ross T, Church D L, Laupland K B
Department of Medicine, University of Calgary, Calgary Health Region, Calgary, Alberta, Canada.
J Infect. 2008 Sep;57(3):198-203. doi: 10.1016/j.jinf.2008.06.018. Epub 2008 Jul 30.
To define the incidence, risk factors for acquisition, and outcomes associated with clostridial bacteremia in a large Canadian health region.
Retrospective population-based surveillance for clostridial bacteremia was conducted among all residents of the Calgary Health Region (population 1.2 million) during 2000-2006.
One hundred and thirty-eight residents had incident Clostridium species bacteremia (1.8 per 100,000/year); 45 (33%) were nosocomial, 55 (40%) were healthcare-associated community onset, and 38 (28%) were community acquired. Older age and a number of underlying conditions were risk factors for acquiring Clostridium species bacteremia most importantly hemodialysis [relative risk (RR) 212.3; 95% confidence interval (CI) 106.5-385.5], malignancy (RR 40.2; 95% CI 27.6-58.1), and Crohn's disease (RR 11.2; 95% CI 3.0-29.4). Clostridium perfringens was most commonly identified with 58 (42%) isolates followed by Clostridium septicum (19; 14%), Clostridium ramosum (13; 9%), Clostridium clostridiiforme (8; 6%), and Clostridium difficile (7; 5%). Reduced susceptibility to penicillin occurred in 14/135 (10%), to metronidazole in 2/135 (1%), and to clindamycin in 36/135 (27%) isolates. The median length of stay was 12.7 days and 39/130 (30%) patients died in hospital for mortality rate of 0.5 per 100,000/year.
Clostridium species bacteremia is associated with a significant burden of illness and hemodialysis and cancer patients are at highest risk.
确定加拿大一个大型健康区域内梭菌属菌血症的发病率、感染风险因素及相关结局。
2000年至2006年期间，对卡尔加里健康区域（人口120万）的所有居民进行基于人群的梭菌属菌血症回顾性监测。
138名居民发生梭菌属菌血症（每年每10万人中有1.8例）；45例（33%）为医院感染，55例（40%）为医疗保健相关社区发病，38例（28%）为社区获得性感染。高龄和一些基础疾病是发生梭菌属菌血症的风险因素，最重要的是血液透析（相对风险[RR]212.3；95%置信区间[CI]106.5 - 385.5）、恶性肿瘤（RR 40.2；95% CI 27.6 - 58.1）和克罗恩病（RR 11.2；95% CI 3.0 - 29.4）。产气荚膜梭菌最常见，有58株（42%）分离株，其次是败血梭菌（19株；14%）、多枝梭菌（13株；9%）、梭形梭菌（8株；6%）和艰难梭菌（7株；5%）。14/135（10%）的分离株对青霉素敏感性降低，2/135（1%）对甲硝唑敏感性降低，36/135（27%）对克林霉素敏感性降低。中位住院时间为12.7天，39/130（30%）的患者在医院死亡，死亡率为每年每10万人中有0.5例。
梭菌属菌血症与严重疾病负担相关，血液透析患者和癌症患者风险最高。
