Department of Microbiology, Old Medical School, Leeds General Infirmary, Thoresby Place, Leeds LS1 3EX, United Kingdom.
Clin Infect Dis. 2012 Oct;55(8):1056-63. doi: 10.1093/cid/cis614. Epub 2012 Jul 11.
Marked increases in Clostridium difficile infection (CDI) incidence, driven by epidemic strain spread, is a global phenomenon.
The Clostridium difficile Ribotyping Network (CDRN) was established in 2007 as part of enhanced CDI surveillance in England, to facilitate the recognition and control of epidemic strains. We report on changes in CDI epidemiology in England in the first 3 years of CDRN.
CDRN received 12,603 fecal specimens, comprising significantly (P < .05) increasing numbers and proportions of national CDI cases in 2007-2008 (n = 2109, 3.8%), 2008-2009 (n = 4774, 13.2%), and 2009-2010 (n = 5720, 22.3%). The C. difficile recovery rate was 90%, yielding 11,294 isolates for ribotyping. Rates of 9 of the 10 most common ribotypes changed significantly (P < .05) during 2007-2010. Clostridium difficile ribotype 027 predominated, but decreased markedly from 55% to 36% and 21% in 2007-2008, 2008-2009, and 2009-2010, respectively. The largest regional variations in prevalence occurred for ribotypes 027, 002, 015, and 078. Cephalosporin and fluoroquinolone use in CDI cases was reported significantly (P < .05) less frequently during 2007-2010. Mortality data were subject to potential reporting bias, but there was a significant decrease in CDI-associated deaths during 2007-2010, which may have been due to multiple factors, including reduced prevalence of ribotype 027.
Access to C. difficile ribotyping was associated with significant changes in the prevalence of epidemic strains, especially ribotype 027. These changes coincided with markedly reduced CDI incidence and related mortality in England. CDI control programs should include prospective access to C. difficile typing and analysis of risk factors for CDI and outcomes.
产毒艰难梭菌（CDI）感染率的显著增加是由流行株传播引起的，这是一种全球现象。
艰难梭菌核糖体分型网络（CDRN）于 2007 年成立，作为英国增强 CDI 监测的一部分，以促进对流行株的识别和控制。我们报告了 CDRN 成立的头 3 年英格兰 CDI 流行病学的变化。
CDRN 收到了 12603 份粪便标本，2007-2008 年（n = 2109，3.8%）、2008-2009 年（n = 4774，13.2%）和 2009-2010 年（n = 5720，22.3%）国家 CDI 病例的数量和比例均显著增加（P <.05）。艰难梭菌的回收率为 90%，共进行了 11294 株的核糖体分型。2007-2010 年间，10 种最常见核糖体型中的 9 种的发生率均发生了显著变化（P <.05）。艰难梭菌核糖体型 027 占主导地位，但在 2007-2008 年、2008-2009 年和 2009-2010 年分别显著下降了 55%、36%和 21%。在流行率方面，核糖体型 027、002、015 和 078 存在最大的地区差异。2007-2010 年，CDI 病例中头孢菌素和氟喹诺酮类药物的使用报告显著减少（P <.05）。CDI 相关死亡率的数据可能存在报告偏倚，但 2007-2010 年间 CDI 相关死亡人数显著下降，这可能是由于多种因素造成的，包括核糖体型 027 的流行率降低。
艰难梭菌核糖体分型的获得与流行株流行率的显著变化有关，特别是核糖体型 027。这些变化与英格兰 CDI 发病率和死亡率的显著下降同时发生。CDI 控制计划应包括对艰难梭菌定型的前瞻性评估以及对 CDI 风险因素和结局的分析。
