台湾南部地区一家地区医院住院成人中产毒艰难梭菌定植和感染的影响。
Impact of toxigenic Clostridium difficile colonization and infection among hospitalized adults at a district hospital in southern Taiwan.
机构信息
Department of Internal Medicine, Tainan Hospital, Department of Health, Executive Yuan, Tainan, Taiwan.
出版信息
PLoS One. 2012;7(8):e42415. doi: 10.1371/journal.pone.0042415. Epub 2012 Aug 2.
BACKGROUND
The impact of toxigenic Clostridium difficile colonization (tCDC) in hospitalized patients is not clear.
AIM
To study the significance of tCDC in hospitalized patients.
METHODS
A prospective study in the medical wards of a regional hospital was performed from January to June 2011. Fecal samples collected from patients at the time of admission were tested for tcdB by real-time polymerase chain reaction (PCR) and cultured for C. difficile. The patients were followed up weekly or when they developed diarrhea during hospitalization. If C. difficile was isolated, tcdA and tcdB would be tested by multiplex PCR. The primary outcome was the development of C. difficile-associated diarrhea (CDAD).
FINDINGS
Of 168 patients enrolled, females predominated (87, 51.8%), and the mean patient age was 75.4 years old. Approximately 70% of the patients were nursing home residents, and one third had a recent hospitalization within the prior three months. Twenty-eight (16.7%) patients had tCDC, including 16 (9.5%) patients with tCDC at the time of admission and 12 (7.2%) with tCDC during the follow-up period. With regard to the medications taken during hospitalization, the patients were more likely to have tCDC if they had received more than one class of antibiotics than if they had received monotherapy (odds ratio [OR] 6.67, 95% confidence interval [CI] 1.41-31.56, P = 0.01), particularly if they received a glycopeptide in combination with a cephalosporin or penicillin or a cephalosporin and a carbapenem. More patients with tCDC developed CDAD than those without tCDC (17.9%, 5/28 vs. 1.4%, 2/140, P = 0.002). Overall 7 (4.2%) of the 168 patients developed CDAD, and crude mortality rate of those with and without tCDC was similar (21.4%, 6/28 vs. 19.4%, 27/140, P = 0.79).
CONCLUSION
Recent use of glycopeptides and β-lactam antibiotics is associated with toxigenic C. difficile colonization, which is a risk factor for developing C. difficile-associated diarrhea.
背景
产毒艰难梭菌定植（tCDC）对住院患者的影响尚不清楚。
目的
研究 tCDC 在住院患者中的意义。
方法
2011 年 1 月至 6 月，对一家地区医院内科病房进行前瞻性研究。入院时采集患者粪便标本，采用实时聚合酶链反应（PCR）检测 tcdB，并培养艰难梭菌。每周对患者进行随访，或患者住院期间出现腹泻时进行随访。如果分离出艰难梭菌，采用多重 PCR 检测 tcdA 和 tcdB。主要结局为艰难梭菌相关性腹泻（CDAD）的发生。
结果
共纳入 168 例患者，女性居多（87 例，51.8%），平均年龄为 75.4 岁。约 70%的患者为养老院居民，三分之一的患者在过去三个月内有最近一次住院史。28 例（16.7%）患者存在 tCDC，包括 16 例（9.5%）患者在入院时存在 tCDC，12 例（7.2%）患者在随访期间存在 tCDC。就住院期间使用的药物而言，如果患者接受的抗生素种类超过 1 种，而非单药治疗，更有可能发生 tCDC（比值比 [OR] 6.67，95%置信区间 [CI] 1.41-31.56，P=0.01），尤其是同时使用糖肽类药物联合头孢菌素或青霉素或头孢菌素和碳青霉烯类药物时。发生 tCDC 的患者比未发生 tCDC 的患者更易发生 CDAD（17.9%，5/28 比 1.4%，2/140，P=0.002）。共有 168 例患者中共有 7 例（4.2%）发生 CDAD，有 tCDC 和无 tCDC 的患者的粗死亡率相似（21.4%，6/28 比 19.4%，27/140，P=0.79）。
结论
近期使用糖肽类和β-内酰胺类抗生素与产毒艰难梭菌定植相关，是发生艰难梭菌相关性腹泻的危险因素。
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