Gutiérrez Ramiro L, Riddle Mark S, Porter Chad K
Enteric Diseases Department, Naval Medical Research Center, 503 Robert Grant Ave, 20910, Silver Spring, Maryland, USA.
BMC Infect Dis. 2013 Dec 28;13:609. doi: 10.1186/1471-2334-13-609.
Clostridium difficile associated disease (CDAD) has risen in incidence and the experience in the US military has not been described.
We evaluated the U.S. military's database and identified CDAD cases and demographic characteristics among affected military personnel from 1998 to 2010.
2,423 cases were identified. CDAD incidence was 13.2 cases (95% CI: 12.7-13.7) per 100 K p-yr and increased over study years. CA-CDAD and HA-CDAD incidence was 5.5 (95% CI: 5.2, 5.9) per 100 K p-y and 1.3 (95% CI: 1.2, 1.4) per 1,000 hospitalizations respectively. Females comprised a larger proportion of CA-CDAD than HA-CDAD (25.5% vs. 19.3%; p < 0.001) cases as did Air Force service (29% vs. 23.4%; p < 0.01). On multivariate analysis female gender, Coast Guard or Air Force service, and a married status was associated with CA-CDAD whereas Male gender and Marine Corps service were associated with HA-CDAD cases.
CDAD has increased among military personnel, with female cases more likely to be community associated. Gender, marital status and branch of service had the strongest association with CDAD subtype. Further work is needed to evaluate the epidemiologic factors that have led to these increased rates in otherwise low-risk populations and associated sequelae.
艰难梭菌相关性疾病（CDAD）的发病率呈上升趋势，而美国军队中的情况尚未见报道。
我们评估了美国军队数据库，确定了1998年至2010年期间受影响军事人员中的CDAD病例及人口统计学特征。
共识别出2423例病例。CDAD发病率为每10万人员年13.2例（95%置信区间：12.7 - 13.7），且在研究年份中有所增加。社区获得性CDAD（CA - CDAD）和医院获得性CDAD（HA - CDAD）的发病率分别为每10万人员年5.5例（95%置信区间：5.2，5.9）和每1000例住院患者1.3例（95%置信区间：1.2，1.4）。女性在CA - CDAD病例中所占比例高于HA - CDAD病例（25.5%对19.3%；p < 0.001），空军服役人员也是如此（29%对23.4%；p < 0.01）。多因素分析显示，女性、海岸警卫队或空军服役以及已婚状态与CA - CDAD相关，而男性和海军陆战队服役与HA - CDAD病例相关。
军事人员中CDAD有所增加，女性病例更可能与社区相关。性别、婚姻状况和服役部门与CDAD亚型的关联最为密切。需要进一步开展工作，以评估导致这些低风险人群发病率上升及相关后遗症的流行病学因素。
