Sansone S, Aschbacher R, Staffler M, Bombonato M, Girardi F, Larcher C, Wiedermann C J
Department of Medicine, Central Hospital of Bolzano, Italy.
J Prev Med Hyg. 2009 Jun;50(2):117-20.
The number of patients with severe Clostridium difficile-associated diarrhoea (CDAD) increases. Health care facilities are requested to establish rates of nosocomially acquired CDAD (N-CDAD) to understand the impact of control or prevention measures, and the burden of N-CDAD on health care resources.
Aim of the single-center surveillance project was to establish local prevalence rates of N-CDAD in adult acute care medical patients.
For a period of at least one year, all diarrhoeal stools from inpatients of a general internal medicine ward were tested for Clostridium difficile toxin A. Case record files were retrospectively analysed and questionnaires were completed for patients with positive stool assays who met the case definitions.
During the surveillance period, 2,610 medical patients had been acutely hospitalized. Stools had been submitted to the hospital laboratory from 163 patients (6.2%) because of diarrhoea and were screened for Clostridium difficile cytotoxin. Complete data sets were available for analysis from 150 patients. Of 137 identified potential cases, 77 (56.2%) met the case definitions for nosocomial diarrhoea. Thirteen of the patients with nosocomial diarrhoea (16.9%) were detected positive by the Clostridium difficile toxin A assay. The overall prevalence of N-CDAD among inpatients was 8.7 cases/100 diarrhoeal stools. The mean number ofN-CDAD cases was 62.3 cases/100,000 patient days and 5 cases/1,000 patient admissions. The mean age of N-CDAD patients was 79.4 years (range 71 to 92). All patients were given broad-spectrum antibiotics before acute diarrhoea developed. Four patients died for reasons not directly related to N-CDAD which confirms increased disease severity as an important risk factor.
This single-center surveillance project, which established N-CDAD rates at frequencies currently reported from international surveys, is useful as benchmark and will help in understanding patterns and impact of N-CDAD at the regional level.
重症艰难梭菌相关性腹泻（CDAD）患者数量不断增加。要求医疗机构确定医院获得性CDAD（N-CDAD）的发生率，以了解控制或预防措施的影响以及N-CDAD对医疗资源的负担。
单中心监测项目的目的是确定成年急性护理内科患者中N-CDAD的当地患病率。
在至少一年的时间里，对普通内科病房住院患者的所有腹泻粪便进行艰难梭菌毒素A检测。对病例记录档案进行回顾性分析，并为符合病例定义的粪便检测呈阳性的患者填写问卷。
在监测期间，2610名内科患者急性住院。163名患者（6.2%）因腹泻将粪便送检医院实验室，并进行艰难梭菌细胞毒素筛查。150名患者有完整的数据集可供分析。在137例确定的潜在病例中，77例（56.2%）符合医院内腹泻的病例定义。13例医院内腹泻患者（16.9%）的艰难梭菌毒素A检测呈阳性。住院患者中N-CDAD的总体患病率为8.7例/100份腹泻粪便。N-CDAD病例的平均数量为62.3例/10万患者日和5例/1000例患者入院。N-CDAD患者的平均年龄为79.4岁（范围71至92岁）。所有患者在急性腹泻发生前均接受了广谱抗生素治疗。4例患者因与N-CDAD无直接关系的原因死亡，这证实疾病严重程度增加是一个重要风险因素。
这个单中心监测项目确定的N-CDAD发生率与国际调查目前报告的频率一致，可作为基准，有助于了解区域层面N-CDAD的模式和影响。
