Microbial Pathogenicity Research Laboratory Medical Microbiology, The Chancellor's Building, University of Edinburgh 49, Little France Crescent, Edinburgh EH16 4SB, UK.
J Med Microbiol. 2013 Sep;62(Pt 9):1468-1477. doi: 10.1099/jmm.0.061093-0. Epub 2013 Jun 20.
Three hundred and thirty-five patients with laboratory-confirmed Clostridium difficile infections (CDIs) were studied for epidemiological features, clinical presentation and laboratory markers. They were followed up for 1 year to determine recurrence and mortality. Four hundred and thirty-two episodes were recorded. One year mortality was 41.8 % of which CDI was listed on 20 % of the death certificates. One year recurrence rate was 22.9 %. PCR ribotype 001 was the commonest epidemiological type and ribotype 027 was not detected. High total leucocyte count and low albumin were significantly associated with mortality, as was the absence of a GI-invasive procedure in the 12 weeks preceding CDI diagnosis, probably due to patients being unfit for the procedure. No association with acid suppressants, deletion in the tdcC anti-sigma factor or vancomycin-resistant enterococcus/methicillin-resistant Staphylococcus aureus co-infection was detected. One year mortality was higher in patients who developed recurrent infections (P<0.001). Differences in ribotype were observed in 2.3 %, 11.11 %, 20 % and 32.4 % isolates with time intervals between sampling of 0-20, 21-40, 41-60 and >60 days, respectively, suggesting that the arbitrary cut-off of 28 days to call a repeat infection a reinfection may not be correct in some cases.
对 335 例经实验室确诊的艰难梭菌感染（CDI）患者进行了流行病学特征、临床特征和实验室标志物研究。对他们进行了为期 1 年的随访，以确定复发和死亡率。共记录了 432 例感染。1 年死亡率为 41.8%，其中 CDI 在 20%的死亡证明上被列出。1 年复发率为 22.9%。PCR 核糖型 001 是最常见的流行类型，未检测到核糖型 027。高总白细胞计数和低白蛋白与死亡率显著相关，在 CDI 诊断前 12 周内没有进行 GI 侵袭性操作也与死亡率相关，这可能是因为患者不适合进行该操作。未发现与酸抑制剂、tdcC 抗西格玛因子缺失或万古霉素耐药肠球菌/耐甲氧西林金黄色葡萄球菌合并感染有关。发生反复感染的患者 1 年死亡率更高（P<0.001）。在采样间隔为 0-20、21-40、41-60 和>60 天的时间间隔内，分别有 2.3%、11.11%、20%和 32.4%的分离株存在核糖型差异，这表明将 28 天的任意时间间隔作为再次感染的复发感染的界限可能并不适用于某些情况。
