Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
Epidemiol Infect. 2013 Oct;141(10):2031-8. doi: 10.1017/S0950268812002749. Epub 2012 Dec 6.
The medical records of 84 patients with stool cultures positive for Clostridium difficile during the period August 2007 to June 2009 were retrospectively reviewed. A case of confirmed (toxigenic)C. difficile infection (CDI) was defined by the presence of symptoms (fever, diarrhoea, abdominal discomfort or distension, ileus) and the presence of toxigenic C. difficile. Patients with compatible clinical symptoms and stool cultures positive for non-toxigenic C. difficile isolates were defined as probable (non-toxigenic) CDI cases. Of these 84 patients, 50 (59.5%) were diagnosed as confirmed CDI and 34 (40.5%) as probable CDI. Thirteen (15.5%) of the 84 patients died during their hospital stay. Usage of proton pump inhibitors was a significant independent risk factor for CDI (OR 3.21, P=0.014). Of the 50 isolates associated with confirmed CDI, seven (8.3%) carried binary toxin genes (cdtAB), and six (7.1%) had a deletion in the tcdC gene. The mortality rate in confirmed CDI patients with isolates exhibiting deletion in the tcdC gene (2/6, 33.3%), those with isolates harbouring binary toxin genes (2/7, 28.6%), and those with isolates containing mutations in gyrA (2/7, 28.6%) and gyrB (1/2, 50%) was higher than the overall mortality rate (10/50, 20%) in patients with confirmed CDI.
回顾性分析了 2007 年 8 月至 2009 年 6 月期间 84 例粪便培养艰难梭菌阳性患者的病历。确诊（产毒）艰难梭菌感染（CDI）的病例定义为存在症状（发热、腹泻、腹部不适或膨胀、肠梗阻）和产毒艰难梭菌。具有相容临床症状和粪便培养非产毒艰难梭菌分离株阳性的患者被定义为可能（非产毒）CDI 病例。在这 84 例患者中，50 例（59.5%）被诊断为确诊 CDI，34 例（40.5%）为可能 CDI。84 例患者中有 13 例（15.5%）在住院期间死亡。质子泵抑制剂的使用是 CDI 的一个显著独立危险因素（OR 3.21，P=0.014）。在与确诊 CDI 相关的 50 个分离株中，有 7 个（8.3%）携带二元毒素基因（cdtAB），6 个（7.1%）在 tcdC 基因中有缺失。在 tcdC 基因缺失（2/6，33.3%）、携带二元毒素基因（2/7，28.6%）和 gyrA（2/7，28.6%）和 gyrB（1/2，50%）突变的分离株中，确诊 CDI 患者的死亡率高于总死亡率（10/50，20%）。
