Bruminhent Jackrapong, Wang Zi-Xuan, Hu Carol, Wagner John, Sunday Richard, Bobik Brent, Hegarty Sarah, Keith Scott, Alpdogan Seyfettin, Carabasi Matthew, Filicko-O'Hara Joanne, Flomenberg Neal, Kasner Margaret, Outschoorn Ubaldo Martinez, Weiss Mark, Flomenberg Phyllis
Division of Infectious Diseases and Environmental Medicine, Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania.
Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, Pennsylvania.
Biol Blood Marrow Transplant. 2014 Sep;20(9):1329-34. doi: 10.1016/j.bbmt.2014.04.026. Epub 2014 May 2.
There was an increase in the Clostridium difficile infection (CDI) rate in our bone marrow transplantation unit. To evaluate the role of unit-based transmission, C. difficile screening was performed on adult patients admitted for hematopoietic stem cell transplantation (HSCT) over a 2-year period, and C. difficile isolates were typed. C. difficile testing was performed using a 2-step C. difficile glutamate dehydrogenase antigen plus toxin A/B enzyme immunoassay (EIA) and cytotoxin assay (or molecular toxin assay). Multilocus sequence typing (MLST) was performed on toxin-positive whole stool samples. A retrospective chart review was performed on all patients with a positive toxin assay. Sixteen of 150 patients (10.7%) had toxigenic C. difficile colonization (CDC) on admission. The overall incidence of CDI within 100 days after HSCT was 24.7% (37 of 150). The median time to diagnosis of CDI was 3.5 days after HSCT. In an adjusted logistic regression model, CDC on admission was a significant risk factor for CDI (odds ratio, 68.5; 95% confidence interval, 11.4 to 416.2). MLST on 22 unit patient toxin-positive stool specimens revealed 15 distinct strain types. Further analysis identified at least 1 potential cross-transmission event; some events may have been missed because of incomplete typing from other specimens. Despite aggressive infection control interventions, there was no decline in the number of CDI cases during the study period. These data suggest that prior CDC plays a major role in CDI rates in this high-risk patient population. It remains unclear if CDI was cross-transmitted in the unit.
我们骨髓移植科的艰难梭菌感染（CDI）率有所上升。为评估科室内部传播的作用，对在两年期间因造血干细胞移植（HSCT）入院的成年患者进行了艰难梭菌筛查，并对艰难梭菌分离株进行了分型。使用两步法艰难梭菌谷氨酸脱氢酶抗原加毒素A/B酶免疫测定（EIA）和细胞毒素测定（或分子毒素测定）进行艰难梭菌检测。对毒素阳性的全粪便样本进行多位点序列分型（MLST）。对所有毒素检测呈阳性的患者进行回顾性病历审查。150名患者中有16名（10.7%）入院时存在产毒素艰难梭菌定植（CDC）。HSCT后100天内CDI的总体发生率为24.7%（150例中的37例）。CDI诊断的中位时间为HSCT后3.5天。在调整后的逻辑回归模型中，入院时的CDC是CDI的一个重要危险因素（比值比，68.5；95%置信区间，11.4至416.2）。对22份科室患者毒素阳性粪便标本进行的MLST显示有15种不同的菌株类型。进一步分析发现至少有1起潜在的交叉传播事件；由于其他标本分型不完整，一些事件可能被遗漏。尽管采取了积极的感染控制干预措施，但在研究期间CDI病例数并未下降。这些数据表明，先前的CDC在这一高危患者群体的CDI发生率中起主要作用。目前尚不清楚CDI是否在科室中发生了交叉传播。
