Coia John E
Scottish Salmonella, Shigella and Clostridium difficile Reference Laboratory, Stobhill Hospital, Glasgow G21 3UW, UK.
Int J Antimicrob Agents. 2009 Mar;33 Suppl 1:S9-12. doi: 10.1016/S0924-8579(09)70009-3.
The epidemiology of Clostridium difficile infection (CDI) has changed in recent years, with the occurrence of large outbreaks of infection associated with the emergence of 'hypervirulent' strains, particularly PCR ribotype 027. There has been much speculation as to the nature of the factors responsible for driving the new epidemic of CDI, and various hypotheses have been proposed. These include increases in the size of the population at risk of CDI and/or their susceptibility to infection, increased exposure to the organism, and changes in the virulence/ transmissibility of the pathogen. Resistance to a range of antimicrobial agents, including the fluoroquinolones, is a common feature of these newly emerged strains. This article considers the part antimicrobial resistance may play as a driver for the observed changes in the epidemiology of CDI and presents a model that would support such a role. However, the paucity of definitive evidence for a causal role and the complexity of the epidemiology of CDI are acknowledged. It may be more accurate to view antimicrobial resistance as one of a range of factors which interact to alter the parameters of the 'CDI equation', and thereby determine the size of the CDI problem associated with any given emerging subtype of C. difficile.
近年来，艰难梭菌感染（CDI）的流行病学发生了变化，出现了与“高毒力”菌株（特别是PCR核糖体分型027）出现相关的大规模感染暴发。关于推动CDI新流行的因素的性质有很多猜测，并提出了各种假设。这些因素包括CDI风险人群规模的增加和/或他们对感染的易感性、对该病原体接触的增加以及病原体毒力/传播性的变化。对包括氟喹诺酮类在内的一系列抗菌药物的耐药性是这些新出现菌株的一个共同特征。本文探讨了抗菌药物耐药性可能作为推动CDI流行病学观察到的变化的一个因素所起的作用，并提出了一个支持这一作用的模型。然而，承认缺乏关于因果关系的确切证据以及CDI流行病学的复杂性。将抗菌药物耐药性视为相互作用以改变“CDI方程”参数从而确定与任何给定艰难梭菌新出现亚型相关的CDI问题规模的一系列因素之一可能更准确。
