Division of Infectious Diseases, Duke University Medical Center, Durham, NC 27710, USA.
Am J Med. 2011 Mar;124(3):276.e1-7. doi: 10.1016/j.amjmed.2010.10.013.
The epidemiology of community-associated Clostridium difficile infection is not well known. We performed a multicenter, case-control study to further describe community-associated C. difficile infection and assess novel risk factors.
We conducted this study at 5 sites from October 2006 through November 2007. Community-associated C. difficile infection included individuals with diarrhea, a positive C. difficile toxin, and no recent (12 weeks) discharge from a health care facility. We selected controls from the same clinics attended by cases. We collected clinical and exposure data at the time of illness and cultured residual stool samples and performed ribotyping.
Of 1041 adult C. difficile infections, 162 (15.5%) met criteria for community-associated: 66 case and 114 control patients were enrolled. Case patients were relatively young (median 64 years), female (56%), and frequently required hospitalization (38%). Antimicrobials, malignancy, exposure to high-risk persons, and remote health care exposure were independently associated with community-associated C. difficile infection. In 40% of cases, we could not confirm recent antibiotic exposure. Stomach-acid suppressants were not associated with community-associated infection, and 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors appeared protective. Prevalence of the hypervirulent NAP-1/027 strain was infrequent (17%).
Community-associated C. difficile infection resulted in a substantial health care burden. Antimicrobials are a significant risk factor for community-associated infection. However, other unique factors also may contribute, including person-to-person transmission, remote health care exposures, and 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors. A role for stomach-acid suppressants in community-associated C. difficile infection is not supported.
社区获得性艰难梭菌感染的流行病学情况尚不清楚。我们进行了一项多中心病例对照研究，以进一步描述社区获得性艰难梭菌感染并评估新的危险因素。
我们于 2006 年 10 月至 2007 年 11 月在 5 个地点进行了这项研究。社区获得性艰难梭菌感染包括腹泻、艰难梭菌毒素阳性且最近 12 周内未从医疗机构出院的个体。我们从病例就诊的同一诊所选择对照。我们在发病时收集临床和暴露数据，并培养残余粪便样本进行核糖体分型。
在 1041 例成人艰难梭菌感染中，162 例（15.5%）符合社区获得性感染标准：纳入 66 例病例和 114 例对照患者。病例患者相对年轻（中位数 64 岁）、女性（56%），且常需要住院治疗（38%）。抗生素、恶性肿瘤、接触高危人群和远程医疗接触与社区获得性艰难梭菌感染独立相关。在 40%的病例中，我们无法确认最近使用抗生素。胃酸抑制剂与社区获得性感染无关，而 3-羟基-3-甲基戊二酰辅酶 A 还原酶抑制剂似乎具有保护作用。高毒力 NAP-1/027 株的流行率较低（17%）。
社区获得性艰难梭菌感染给卫生保健带来了巨大负担。抗生素是社区获得性感染的一个重要危险因素。然而，其他独特的因素也可能起作用，包括人际传播、远程医疗暴露和 3-羟基-3-甲基戊二酰辅酶 A 还原酶抑制剂。胃酸抑制剂在社区获得性艰难梭菌感染中的作用不支持。
