Sundram F, Guyot A, Carboo I, Green S, Lilaonitkul M, Scourfield A
Department of Microbiology, Royal Surrey County Hospital and PPS Laboratory, Frimley Park Hospital, Surrey, UK.
J Hosp Infect. 2009 Jun;72(2):111-8. doi: 10.1016/j.jhin.2009.02.020. Epub 2009 Apr 21.
The present study investigates risk factors for onset of Clostridium difficile-associated diarrhoea, specific ribotype and environmental spore contamination in a District General Hospital in South East England. C. difficile isolates were ribotyped from 97 diarrhoeal cases, following detection of C. difficile toxin from faecal specimens by enzyme immunoassay (Health Protection Agency, Southampton). The isolates were tested for various antimicrobial susceptibilities by E-test. Cases were assessed for prior antibiotic use and followed up for clinical outcomes. Controls were matched for age, sex, ward, length of stay and comorbidity to identify any antibiotic risk factors using conditional logistic regression analysis. Environmental sampling on wards was performed with cycloserine-cefoxitin-egg yolk agar. Forty-five percent C.difficile isolates ribotyped as 027, 39% as 106 and 10% as 001. All ribotypes were resistant to ciprofloxacin, erythromycin and cefotaxime but remained susceptible to metronidazole and vancomycin. The crude (death within 28 days) and early (death within 72h) mortalities were 23% and 11% for the 027 strain, whereas for the 106 ribotype they were 11% and 3%, respectively. The case-control study identified ciprofloxacin usage for >7 days as a significant risk factor (adjusted odds ratios of 3.72; 95% CI: 1.38-10.02; P=0.019). Environmental sampling revealed the presence of spores on faecally contaminated equipment such as commodes and bedpan shells, which persisted after cleaning. Ciprofloxacin appears to encourage C.difficile-associated diarrhoea and should be restricted to short courses. Cleaning agents for clinical equipment must have sporicidal activity to prevent cross-transmission.
本研究调查了英格兰东南部一家区综合医院中艰难梭菌相关性腹泻的发病风险因素、特定核糖体分型以及环境孢子污染情况。通过酶免疫测定法（南安普敦健康保护局）从粪便标本中检测出艰难梭菌毒素后，对97例腹泻病例的艰难梭菌分离株进行了核糖体分型。采用E-test法对分离株进行多种抗菌药敏试验。评估病例之前的抗生素使用情况，并对临床结局进行随访。对照组在年龄、性别、病房、住院时间和合并症方面进行匹配，采用条件逻辑回归分析确定任何抗生素风险因素。使用环丝氨酸-头孢西丁-蛋黄琼脂对病房进行环境采样。45%的艰难梭菌分离株核糖体分型为027，39%为106，10%为001。所有核糖体分型对环丙沙星、红霉素和头孢噻肟均耐药，但对甲硝唑和万古霉素仍敏感。027菌株的粗死亡率（28天内死亡）和早期死亡率（72小时内死亡）分别为23%和11%，而106核糖体分型的相应死亡率分别为11%和3%。病例对照研究确定使用环丙沙星超过七天是一个显著的风险因素（调整后的比值比为3.72；95%置信区间：1.38 - 10.02；P = 0.019）。环境采样显示，在诸如马桶和便盆外壳等粪便污染的设备上存在孢子，清洁后孢子仍持续存在。环丙沙星似乎会引发艰难梭菌相关性腹泻，应限制使用疗程。临床设备的清洁剂必须具有杀孢子活性，以防止交叉传播。
