Laval University Faculty of Medicine, Quebec City, QC, Canada; Infectious Diseases Research Centre, Centre Hospitalier Universitaire de Québec, Quebec City, QC, Canada.
Clin Microbiol Infect. 2014 Oct;20(10):1067-73. doi: 10.1111/1469-0691.12676. Epub 2014 Jul 12.
Clinical features of Clostridium difficile infections (CDI) detected by PCR, but not by conventional methods, are poorly understood. We compared the clinical features of CDI cases detected by PCR only and cases detected by both PCR and a three-step algorithm. We performed a retrospective cohort study of patients fulfilling a standardized definition over a 13-month period. Stool specimens were tested in parallel by PCR and an algorithm based on enzyme immunoassay and cytotoxicity assay (EIA/CCA). Clinical features of CDI cases detected by PCR only and cases detected by PCR and EIA/CCA were compared by univariate logistic regression. In all, 97 patients (31 PCR+ and 66 PCR+EIA/CCA+) met the inclusion criteria. Compared with cases detected by both PCR and EIA/CCA, CDI cases detected by PCR only were younger (65.4 versus 76.3 years; p 0.001), had a lower absolute neutrophil count (mean, 9.4 × 10(9) /L versus 12.5 × 10(9) /L; p 0.04), were less likely to receive oral vancomycin (2/31 versus 25/66; p 0.005) or combination therapy (0/31 versus 16/66; p 0.04), and had fewer complications (6/31 versus 29/66; p 0.02), despite presenting a higher number of bowel movements on the day of diagnosis (median, 6.0 versus 3.0; p 0.02). They had also a lower C. difficile faecal bacterial load (mean, 5.04 versus 6.89 log10 CFU/g; p <0.001). The CDI cases detected by PCR only and cases detected by both PCR and EIA/CCA have different clinical features, but whether these two populations can be managed differently remains to be determined.
PCR 检测但常规方法未检测到的艰难梭菌感染（CDI）的临床特征了解甚少。我们比较了仅通过 PCR 检测到的 CDI 病例和通过 PCR 和三步算法同时检测到的 CDI 病例的临床特征。我们在 13 个月的时间内对符合标准化定义的患者进行了回顾性队列研究。粪便标本同时通过 PCR 和基于酶免疫测定和细胞毒性测定的算法（EIA/CCA）进行检测。通过单变量逻辑回归比较仅通过 PCR 检测到的 CDI 病例和通过 PCR 和 EIA/CCA 同时检测到的 CDI 病例的临床特征。共有 97 名患者（31 名 PCR+和 66 名 PCR+EIA/CCA+）符合纳入标准。与通过 PCR 和 EIA/CCA 同时检测到的病例相比，仅通过 PCR 检测到的 CDI 病例更年轻（65.4 岁比 76.3 岁；p<0.001），绝对中性粒细胞计数较低（均值，9.4×10^9/L 比 12.5×10^9/L；p=0.04），不太可能接受口服万古霉素（2/31 比 25/66；p=0.005）或联合治疗（0/31 比 16/66；p=0.04），并发症较少（6/31 比 29/66；p=0.02），尽管诊断当天的排便次数更多（中位数，6.0 比 3.0；p=0.02）。它们的艰难梭菌粪便细菌负荷也较低（均值，5.04 比 6.89 log10 CFU/g；p<0.001）。仅通过 PCR 检测到的 CDI 病例和通过 PCR 和 EIA/CCA 同时检测到的 CDI 病例具有不同的临床特征，但这两个群体是否可以采用不同的方法进行管理仍有待确定。
