European Programme for Intervention Epidemiology Training, Stockholm, Sweden.
Emerg Infect Dis. 2011 Jun;17(6):976-82. doi: 10.3201/eid/1706.101483.
We compared 30-day case-fatality rates for patients infected with Clostridium difficile possessing genes for toxins A and B without binary toxin (n = 212) with rates for patients infected with C. difficile possessing genes for A, B, and binary toxin. The latter group comprised patients infected with strains of PCR ribotype 027 (CD027, n = 193) or non-027 (CD non-027, n = 72). Patients with binary toxin had higher case-fatality rates than patients without binary toxin, in univariate analysis (relative risk [RR] 1.8, 95% confidence interval [CI] 1.2-2.7) and multivariate analysis after adjustment for age, sex, and geographic region (RR 1.6, 95% CI 1.0-2.4). Similar case-fatality rates (27.8%, 28.0%) were observed for patients infected with CD027 or CD non-027. Binary toxin either is a marker for more virulent C. difficile strains or contributes directly to strain virulence. Efforts to control C. difficile infection should target all virulent strains irrespective of PCR ribotype.
我们比较了携带 A、B 毒素基因而无二元毒素基因的艰难梭菌（n = 212）感染患者与携带 A、B 和二元毒素基因的艰难梭菌感染患者的 30 天病死率。后一组包括感染 PCR 核糖体分型 027（CD027，n = 193）或非 027（CD 非 027，n = 72）株的患者。在单变量分析（相对风险 [RR] 1.8，95%置信区间 [CI] 1.2-2.7）和调整年龄、性别和地理区域后的多变量分析中，携带二元毒素的患者病死率高于未携带二元毒素的患者（RR 1.6，95%CI 1.0-2.4）。感染 CD027 或 CD 非 027 的患者病死率相似（27.8%，28.0%）。二元毒素要么是更具毒力的艰难梭菌菌株的标志物，要么直接导致菌株毒力增强。控制艰难梭菌感染的努力应针对所有具有毒力的菌株，而不论其 PCR 核糖体分型如何。
