R M Alden Research Laboratory, Culver City, CA 90230, USA.
Anaerobe. 2009 Dec;15(6):241-3. doi: 10.1016/j.anaerobe.2009.06.009. Epub 2009 Aug 13.
C. difficile infection (CDI) is a common nosocomial infection in hospitals and impacts increased hospital cost and length of stay. Since scant information is available about the incidence and prevalence of CDI in Long-term acute care hospitals (LTACs), we therefore studied this at one local facility.
Demographic and other data, and a fresh stool sample were obtained from all new LTAC admissions not carrying a prior diagnosis of CDI during the study period (July 23 to August 22, 2007). A GDH test for C. difficile antigen was performed. All initially positive stools were tested for toxins A and B and a sample was frozen for culture and typing. All antigen-negative patients were monitored for the development of diarrhea during the course of their LTAC hospitalization and, if clinically indicated, a sample was sent for toxins A and B testing and if positive, a stool sample was frozen and stored for culture and typing. Therapy of CDI was noted.
36 patients were admitted during the study period. 4 of 31 (12.9%) of patients tested were antigen (+) on admission of which 2 (6.5%) were asymptomatic carriers and 2 (6.5%) had unsuspected active disease, including one with the BI epidemic strain. In follow-up, 20/36 (55.5%) developed diarrhea of which an additional 5 (13.8%) patients had developed CDI (average, hospital day 38) in the hospital. Therapy was instituted with vancomycin in 5/7 patients and metronidazole in 2/7 patients. During that quarter, the rate of nosocomial acquired CDI was 3.12 per 1000 patient days.
C. difficile carriage and unsuspected clinical CDI occurs, including with the BI epidemic strain disease, in an important minority of patients, which may act as a reservoir for spread. New strategies for detection and prevention of CDI are needed.
艰难梭菌感染（CDI）是医院内常见的医院获得性感染，会增加医院的成本和住院时间。由于关于长期急性护理医院（LTAC）中 CDI 的发病率和患病率的信息很少，因此我们在当地的一家医院进行了这项研究。
在研究期间（2007 年 7 月 23 日至 8 月 22 日），从所有新入院的 LTAC 患者中获取人口统计学和其他数据以及新鲜粪便样本，这些患者在入院时没有携带 CDI 的先前诊断。进行艰难梭菌抗原的 GDH 检测。所有最初阳性的粪便均进行毒素 A 和 B 的检测，并且样本被冷冻用于培养和分型。所有抗原阴性的患者在 LTAC 住院期间监测腹泻的发生情况，如果临床需要，进行毒素 A 和 B 的检测，如果阳性，则冷冻粪便样本并储存用于培养和分型。记录 CDI 的治疗情况。
在研究期间共收治 36 例患者。31 例患者中有 4 例（12.9%）在入院时抗原检测呈阳性，其中 2 例（6.5%）为无症状携带者，2 例（6.5%）患有未被怀疑的活动性疾病，包括 1 例带有 BI 流行株。在随访中，20/36（55.5%）出现腹泻，其中另外 5 例（13.8%）患者在医院内发展为 CDI（平均住院日为 38 天）。7 例患者中有 5 例接受了万古霉素治疗，2 例接受了甲硝唑治疗。在该季度，医院获得性 CDI 的发生率为每 1000 个患者日 3.12 例。
艰难梭菌携带和未被怀疑的临床 CDI 发生，包括 BI 流行株疾病，在少数重要患者中发生，这可能成为传播的储库。需要新的检测和预防 CDI 的策略。
