Jansen Andreas, Kleinkauf N, Weiss B, Zaiss N H, Witte W, Bornhofen B, Kist M, von Eichel-Streiber C, Neumann M, Michels H, Eckmanns T
Robert Koch-Institut, Abteilung für Infektionsepidemiologie, Berlin.
Z Gastroenterol. 2010 Sep;48(9):1120-5. doi: 10.1055/s-0029-1245269. Epub 2010 Sep 13.
In September 2007 an increase of severe Clostridium difficile-associated infections (CDI) was noticed in a hospital in the city of Trier, Germany. It was assumed that a new, possibly hypervirulent strain (PCR ribotype 027) was related to these events. An outbreak investigation was initiated by the local health authorities and the Robert Koch Institute to describe the epidemiology of the possible outbreak and to identify and control the possible sources.
In addition to retrospective case-finding of severe CDI and ribotype 027 infections by analysis of patient documents and certificates of death, an active surveillance system for severe CDI and ribotype 027 infections was established in the 6 hospitals of the affected region. In all suspected cases, a test for toxin A/B and a stool culture for C. difficile were conducted simultaneously. Bacterial isolates were further characterised by PCR ribotyping. Data on the course of disease, case fatality, and possible risk factors for CDI-related deaths were assessed using a standardised questionnaire. Environmental investigations were done.
By 31 January 2008, 27 cases of severe CDI and 21 cases with C. difficile ribotype 027 infections were found in the area under investigation. Active surveillance found 76 of 399 (19 %) patients positive for C. difficile. In 20 patients, PCR ribotyp 027 could be proven. In total, 9 deaths occurred (19 %). An existing immunosupressive therapy (OR 35.8; 95 % CI 2.8 - 464.5) was related to case fatality in the multivariate analysis. Severe cases of CDI were also observed in non-ribotype 027 infections. In the screening of hospital personnel (n = 161), 6 % were found positive for toxin A/B.
This investigation demonstrated the endemicity of C. difficile PCR ribotype 027 in Germany for the first time. As a consequence from this study, severe CDI became a reportable disease in Germany at the end of 2007. In addition to hygienic measures, the critical use of antibiotics is an important measure to prevent a further increase of CDI.
2007年9月，德国特里尔市一家医院发现艰难梭菌相关性严重感染（CDI）病例有所增加。据推测，一种新的、可能具有高毒力的菌株（PCR核糖体分型027）与这些事件有关。当地卫生当局和罗伯特·科赫研究所发起了一项疫情调查，以描述可能的疫情流行病学特征，并确定和控制可能的传染源。
除了通过分析患者病历和死亡证明对严重CDI和核糖体分型027感染进行回顾性病例查找外，还在受影响地区的6家医院建立了严重CDI和核糖体分型027感染的主动监测系统。在所有疑似病例中，同时进行毒素A/B检测和艰难梭菌粪便培养。细菌分离株通过PCR核糖体分型进一步鉴定。使用标准化问卷评估疾病进程、病死率以及CDI相关死亡的可能危险因素。开展了环境调查。
截至2008年1月31日，在调查区域内发现了27例严重CDI病例和21例艰难梭菌核糖体分型027感染病例。主动监测发现399名患者中有76名（19%）艰难梭菌检测呈阳性。在20名患者中，PCR核糖体分型027得到证实。总共发生了9例死亡（19%）。多因素分析显示，现有的免疫抑制治疗（比值比35.8；95%置信区间2.8 - 464.5）与病死率相关。在非核糖体分型027感染中也观察到了严重的CDI病例。在对医院工作人员（n = 161）的筛查中，发现6%的人毒素A/B检测呈阳性。
本次调查首次证明了艰难梭菌PCR核糖体分型027在德国的地方性流行。基于这项研究的结果，严重CDI于2007年底在德国成为须报告的疾病。除了卫生措施外，严格使用抗生素是预防CDI进一步增加的重要措施。
