Microbial Pathogenicity Research Laboratory, Medical Microbiology, The Chancellors Building, University of Edinburgh, 49, Little France Crescent, Edinburgh EH16 4SB, UK.
Microbial Pathogenicity Research Laboratory, Medical Microbiology, The Chancellors Building, University of Edinburgh, 49, Little France Crescent, Edinburgh EH16 4SB, UK.
J Infect. 2014 Aug;69(2):134-44. doi: 10.1016/j.jinf.2014.04.002. Epub 2014 Apr 26.
This prospective study was performed to determine the incidence, risk factors, severity and outcomes of community-associated Clostridium difficile infection (CA-CDI) in the SE of Scotland.
All patients (335) diagnosed with laboratory confirmed CDI in the city of Edinburgh, East Lothian and Midlothian regions of Scotland between August 2010 and July 2011 were followed up for one year after diagnosis. Clinical details and laboratory markers were recorded. Stool samples were tested for C. difficile, other bacterial pathogens and norovirus. Molecular epidemiology of C. difficile isolates was studied by PCR-ribotyping.
Of the total 335 confirmed CDI cases, PCR-ribotype 001 was the commonest (14.1%), followed by PCR-ribotypes 078 (12.9%) and 015 (11.7%), respectively. CA-CDI represented 12.5% of the cases. In these, PCR-ribotype 078 was the commonest (19.0%), followed by PCR-ribotypes 014/020 (16.7%), PCR-ribotype 015 (14.3% and PCR-ribotype 001 (11.9%). A lower Charlson co-morbidity index and a lower age was observed in the CA-CDI group as was total number of different antibiotic classes whereas age >75 was more common in the HA-CDI group. On multivariable analysis presence of PCR-ribotype 078 was significantly associated with community acquisition (p = 0.006) whereas a greater proportion of immunosuppressed patients and those on antibiotics 8 weeks preceding diagnosis (p = 0.035 and p = 0.005 respectively) were found among HA-CDI cases. Charlson co-morbidity index, number of different antibiotics given in the eight weeks preceding onset, severity of infection and rural residence were not significantly different between the two groups.
This study demonstrates that patients with CA-CDI may also present with severe infection, are less likely to receive antibiotics prior to CDI, more likely to be younger in age and have a greater proportion of PCR-ribotype 078 compared with CDI acquired in a hospital setting. Hence a high level of vigilance must be maintained to detect CDI cases which present in the community without the traditional predisposing factors.
本前瞻性研究旨在确定苏格兰东南部社区获得性艰难梭菌感染（CA-CDI）的发生率、危险因素、严重程度和结局。
2010 年 8 月至 2011 年 7 月，在苏格兰爱丁堡市、东洛锡安区和中洛锡安区，对所有经实验室确诊为 CDI 的患者（335 例）进行了随访，随访时间为诊断后 1 年。记录临床详细信息和实验室标志物。对粪便样本进行艰难梭菌、其他细菌病原体和诺如病毒检测。通过 PCR-核糖体分型研究艰难梭菌分离株的分子流行病学。
在 335 例确诊的 CDI 病例中，PCR-核糖体 001 型最为常见（14.1%），其次是 PCR-核糖体 078 型（12.9%）和 015 型（11.7%）。CA-CDI 占病例的 12.5%。在这些病例中，PCR-核糖体 078 型最为常见（19.0%），其次是 PCR-核糖体 014/020 型（16.7%）、PCR-核糖体 015 型（14.3%）和 PCR-核糖体 001 型（11.9%）。CA-CDI 组的 Charlson 合并症指数和年龄较低，使用的不同抗生素类别总数也较少，而 HA-CDI 组中年龄>75 岁的患者更为常见。多变量分析显示，PCR-核糖体 078 型与社区获得性感染显著相关（p=0.006），而在 HA-CDI 病例中，免疫抑制患者和在诊断前 8 周使用抗生素的患者比例更高（p=0.035 和 p=0.005）。两组间 Charlson 合并症指数、发病前 8 周使用的不同抗生素数量、感染严重程度和农村居住情况无显著差异。
本研究表明，CA-CDI 患者也可能出现严重感染，在发生 CDI 之前接受抗生素治疗的可能性较小，年龄较小，PCR-核糖体 078 型的比例较高，与在医院环境中获得的 CDI 相比。因此，必须保持高度警惕，以发现社区中没有传统诱发因素的 CDI 病例。
