Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea.
Clin Microbiol Infect. 2013 Jun;19(6):521-7. doi: 10.1111/j.1469-0691.2012.03910.x. Epub 2012 Jun 19.
To survey healthcare-associated Clostridium difficile infection (HA-CDI) in a 900-bed tertiary-care hospital, we prospectively investigated the epidemiology of CDI and distribution of PCR-ribotypes. From February 2009 through January 2010, all patients with HA-CDI were enrolled. Epidemiological information and prescription records for antibiotics were collected. The C. difficile isolates were characterized using reference strains and were tested for antibiotic susceptibility. During the survey, incidence of HA-CDI was 71.6 per 100 000 patient-days. In total, 140 C. difficile isolates were obtained from 166 patients with HA-CDI. The PCR-ribotyping yielded 38 distinct ribotypes. The three most frequently found ribotypes made up 56.4% of all isolates; they comprised 37 isolates (26.4%) of PCR-ribotype 018, 22 (15.7%) of toxin A-negative PCR-ribotype 017, and 20 (14.3%) of PCR-ribotype 001. Clostridium difficile PCR-ribotype 018 was present in all departments throughout the hospital during the 11 months, whereas ribotype 017 and ribotype 001 appeared mostly in the pulmonary department. Hypervirulent C. difficile PCR-ribotype 027 was detected in 1 month on two wards. The incidence of CDI in each department showed a seven-fold difference, which correlated significantly with the amount of prescribed clindamycin (R = 0.783, p 0.013) or moxifloxacin (R = 0.733, p 0.025) in the departments. The rates of resistance of the three commonest ribotypes to clindamycin and moxifloxacin were significantly higher than those of other strains (92.1% versus 38.2% and 89.5% versus 27.3%, respectively). CDI is an important nosocomially acquired infection and this study emphasizes the importance of implementing country-wide surveillance to detect and control CDI in Korea.
为了调查 900 张病床的三级保健医院中与保健相关的艰难梭菌感染（HA-CDI），我们前瞻性地调查了 CDI 的流行病学和 PCR-核糖体分型的分布。从 2009 年 2 月至 2010 年 1 月，所有患有 HA-CDI 的患者均被纳入研究。收集流行病学信息和抗生素处方记录。使用参考菌株对艰难梭菌分离株进行特征描述，并测试其抗生素敏感性。在调查期间，HA-CDI 的发生率为每 100000 个患者日 71.6 例。共有 166 例 HA-CDI 患者的 140 株艰难梭菌分离株。PCR-核糖体分型产生了 38 种不同的核糖体型。三种最常见的核糖体型占所有分离株的 56.4%；它们包括 37 株（26.4%）PCR-核糖体型 018、22 株（15.7%）产毒素 A 阴性的 PCR-核糖体型 017 和 20 株（14.3%）PCR-核糖体型 001。在 11 个月的时间里，医院所有科室均存在 PCR-核糖体型 018，而核糖体型 017 和核糖体型 001 主要存在于肺部科室。在 2 个病房的 1 个月内检测到了高毒力的艰难梭菌 PCR-核糖体型 027。各科室的 CDI 发生率相差 7 倍，与科室中规定的克林霉素（R = 0.783，p 0.013）或莫西沙星（R = 0.733，p 0.025）的用量显著相关。三种最常见的核糖体型对克林霉素和莫西沙星的耐药率明显高于其他菌株（分别为 92.1%对 38.2%和 89.5%对 27.3%）。CDI 是一种重要的医院获得性感染，本研究强调了在韩国实施全国性监测以发现和控制 CDI 的重要性。
