Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands.
Clin Microbiol Infect. 2009 Dec;15(12):1087-92. doi: 10.1111/j.1469-0691.2009.02853.x. Epub 2009 Jul 16.
To elucidate the prevalence, characteristics and risk factors of community-onset Clostridium difficile infection (CO-CDI), an uncontrolled prospective study was performed. For 3 months in 2007-2008, three laboratories in The Netherlands tested all unformed stool samples submitted by general practitioners (GPs) for C. difficile by enzyme immunoassay for toxins A and B, irrespective of whether GPs specifically requested this. Patients with positive results were asked to complete a questionnaire. Positive stool samples were cultured for C. difficile, and isolates were characterized. In all, 2443 stool samples from 2423 patients were tested, and 37 patients (1.5%) with positive toxin test results were identified. Mixed infections were not found. Age varied from 1 to 92 years, and 18% were under the age of 20 years. Diarrhoea was typically frequent and watery, sometimes with admixture of blood or fever. Eight of 28 patients (29%) suffered recurrences. Among 31 patients with toxin-positive stool samples for whom information was available, 20 (65%) had not been admitted to a healthcare institution in the year before, 13 (42%) had not used antibiotics during the 6 months before, and eight (26%) had neither risk factor. A separate analysis for patients whose samples were both toxin-positive and culture-positive produced similar results. Cultured C. difficile isolates belonged to 13 different PCR ribotypes, and 24% of the isolates were non-typeable (rare or new) PCR ribotypes. In conclusion, CO-CDI can affect all age groups, and many patients do not have known risk factors. Several PCR ribotypes not encountered in hospital-associated outbreaks were found, suggesting the absence of a direct link between outbreaks and community-onset cases.
为了阐明社区获得性艰难梭菌感染（CO-CDI）的流行率、特征和危险因素，开展了一项未设对照的前瞻性研究。2007 年至 2008 年 3 个月期间，荷兰的三个实验室采用酶联免疫吸附试验（EIA）检测所有未经成形粪便样本中的艰难梭菌毒素 A 和 B，不论全科医生（GP）是否特别要求进行此项检测。对检测结果阳性的患者要求其填写一份问卷。对阳性粪便样本进行艰难梭菌培养，并对分离株进行特征分析。共检测了 2423 名患者的 2443 份粪便样本，发现 37 名（1.5%）患者毒素检测结果阳性。未发现混合感染。患者年龄为 1 至 92 岁，18%的患者年龄小于 20 岁。腹泻通常频繁且呈水样，有时伴有血液或发热。28 名复发性感染患者中有 8 名（29%）。在 31 名毒素检测阳性且可获得信息的患者中，20 名（65%）在发病前 1 年内未住院，13 名（42%）在发病前 6 个月内未使用抗生素，8 名（26%）两者均无。对粪便毒素检测和培养均为阳性的患者进行的单独分析得出了相似的结果。培养的艰难梭菌分离株属于 13 种不同的 PCR 核糖体分型，24%的分离株为无法定型（罕见或新型）PCR 核糖体分型。总之，CO-CDI 可影响所有年龄段的人群，许多患者没有已知的危险因素。发现了一些与医院相关性暴发无关的 PCR 核糖体分型，提示暴发和社区获得性病例之间不存在直接联系。
