Thibault A, Miller M A, Gaese C
Department of Microbiology, Montreal General Hospital, Quebec, Canada.
Infect Control Hosp Epidemiol. 1991 Jun;12(6):345-8. doi: 10.1086/646354.
To evaluate the risk factors associated with a nosocomial outbreak of Clostridium difficile-associated diarrhea.
Case-control study with two control groups.
University-affiliated urban hospital.
A convenience sample of 26 patients was chosen out of a total of 78 hospitalized patients with C difficile-associated diarrhea, defined as the presence of diarrhea and a positive C difficile cytotoxin assay or stool culture. Twenty-six controls were matched for age, gender, ward, and date of admission; 18 additional controls were matched to surgical patients for date and ward of admission, as well as for the type of surgical procedure performed.
Significant risk factors for the development of C difficile-associated diarrhea were gastrointestinal surgery (exposure odds ratio [EOR] = 7.9, p = .004, 95% confidence interval [CI] = 1.9, 35), use of neomycin (EOR = 15.6, p = .012, 95% CI = 1.7, 92), clindamycin (EOR = 15.6, p = .005, 95% CI = 1.7, 92), metronidazole (EOR = 5.7, p = .02, 95% CI = 1.4, 25), and excess antibiotic use (mean number of antibiotics = 4.2 versus 1.4, p less than .00005). The presence of systemic disease and the use of antacids or immunosuppressive drugs were similar in cases and controls. In surgical patients, no specific antibiotic could be linked to C difficile-associated diarrhea because of uniform perioperative antibiotic use. There was a significant difference in the number of antibiotics administered to cases and controls (mean = 3.1 versus 1.9, p less than .005).
The results suggest that control of nosocomial C difficile-associated diarrhea may be attained by minimizing the administration of antibiotics, avoidance of high-risk antibiotics, and having a high index of suspicion of C difficile-associated diarrhea in patients who develop diarrhea after gastrointestinal surgery. Perioperative administration of metronidazole, when given with other antibiotics, failed to protect against the development of C difficile-associated diarrhea.
评估与艰难梭菌相关性腹泻医院感染暴发相关的危险因素。
设有两个对照组的病例对照研究。
大学附属医院。
从78例住院的艰难梭菌相关性腹泻患者中选取26例作为便利样本，艰难梭菌相关性腹泻定义为存在腹泻且艰难梭菌细胞毒素检测或粪便培养呈阳性。26名对照在年龄、性别、病房和入院日期方面进行匹配；另外18名对照在入院日期、病房以及所实施的外科手术类型方面与外科患者进行匹配。
发生艰难梭菌相关性腹泻的显著危险因素包括胃肠道手术（暴露比值比[EOR]=7.9，p = 0.004，95%置信区间[CI]=1.9, 35）、使用新霉素（EOR = 15.6，p = 0.012，95% CI = 1.7, 92）、克林霉素（EOR = 15.6，p = 0.005，95% CI = 1.7, 92）、甲硝唑（EOR = 5.7，p = 0.02，95% CI = 1.4, 25）以及抗生素过度使用（抗生素平均使用数量=4.2对比1.4，p小于0.00005）。病例组和对照组全身性疾病的存在情况以及抗酸剂或免疫抑制药物的使用情况相似。在外科患者中，由于围手术期抗生素使用一致，没有特定抗生素可与艰难梭菌相关性腹泻相关联。病例组和对照组给予的抗生素数量存在显著差异（平均=3.1对比1.9，p小于0.005）。
结果表明，通过尽量减少抗生素的使用、避免使用高风险抗生素以及对胃肠道手术后发生腹泻的患者高度怀疑艰难梭菌相关性腹泻，可实现对医院内艰难梭菌相关性腹泻的控制。围手术期给予甲硝唑并与其他抗生素合用时，未能预防艰难梭菌相关性腹泻的发生。
