Ziakas Panayiotis D, Zacharioudakis Ioannis M, Zervou Fainareti N, Grigoras Christos, Pliakos Elina Eleftheria, Mylonakis Eleftherios
Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America.
PLoS One. 2015 Feb 23;10(2):e0117195. doi: 10.1371/journal.pone.0117195. eCollection 2015.
The impact of Clostridium difficile colonization in C. difficile infection (CDI) is inadequately explored. As a result, asymptomatic carriage is not considered in the development of infection control policies and the burden of carrier state in long-term care facilities (LTCFs) is unknown.
To explore the epidemiology of C. difficile colonization in LTCFs, identify predisposing factors and describe its impact on healthcare management.
PubMed, Embase and Web of Science (up to June 2014) without language restriction, complemented by reference lists of eligible studies.
All studies providing extractable data on the prevalence of toxigenic C. difficile colonization among asymptomatic residents in LTCFs.
Two authors extracted data independently.
The pooled colonization estimates were calculated using the double arcsine methodology and reported along with their 95% random-effects confidence intervals (CIs), using DerSimonian-Laird weights. We assessed the impact of patient-level covariates on the risk of colonization and effects were reported as odds ratios (OR, 95% CI). We used the colonization estimates to simulate the effective reproduction number R through a Monte Carlo technique.
Based on data from 9 eligible studies that met the specified criteria and included 1,371 subjects, we found that 14.8% (95%CI 7.6%-24.0%) of LTCF residents are asymptomatic carriers of toxigenic C. difficile. Colonization estimates were significantly higher in facilities with prior CDI outbreak (30.1% vs. 6.5%, p = 0.01). Patient history of CDI (OR 6.07; 95% CI 2.06-17.88; effect derived from 3 studies), prior hospitalization (OR 2.11; 95% CI 1.08-4.13; derived from 3 studies) and antimicrobial use within previous 3 months (OR 3.68; 95% CI 2.04-6.62; derived from 4 studies) were associated with colonization. The predicted colonization rate at admission was 8.9%.
Asymptomatic carriage of toxigenic C. difficile represents a significant burden in LTCFs and is associated with prior CDI outbreaks in the facility, a history of CDI, prior hospitalization and antimicrobial use. These findings can impact infection control measures at LTCFs.
艰难梭菌定植在艰难梭菌感染（CDI）中的影响尚未得到充分研究。因此，在制定感染控制政策时未考虑无症状携带情况，长期护理机构（LTCF）中携带者状态的负担也未知。
探讨长期护理机构中艰难梭菌定植的流行病学，确定易感因素并描述其对医疗管理的影响。
PubMed、Embase和科学网（截至2014年6月），无语言限制，并辅以符合条件研究的参考文献列表。
所有提供长期护理机构无症状居民中产毒艰难梭菌定植患病率可提取数据的研究。
两位作者独立提取数据。
使用双反正弦方法计算合并的定植估计值，并使用DerSimonian-Laird权重报告其95%随机效应置信区间（CI）。我们评估了患者层面协变量对定植风险的影响，并将效应报告为比值比（OR，95%CI）。我们使用定植估计值通过蒙特卡罗技术模拟有效繁殖数R。
基于9项符合指定标准且包括1371名受试者的合格研究数据，我们发现14.8%（95%CI7.6%-24.0%）的长期护理机构居民是产毒艰难梭菌的无症状携带者。在有既往CDI暴发的机构中，定植估计值显著更高（30.1%对6.5%，p=0.01）。CDI患者病史（OR6.07；95%CI2.06-17.88；效应来自3项研究）、既往住院史（OR2.11；95%CI1.08-4.13；来自3项研究）以及前3个月内使用抗菌药物（OR3.68；95%CI2.04-6.62；来自4项研究）与定植相关。入院时预测的定植率为8.9%。
产毒艰难梭菌的无症状携带在长期护理机构中是一个重大负担，并且与机构既往CDI暴发、CDI病史、既往住院史和抗菌药物使用有关。这些发现可能会影响长期护理机构的感染控制措施。
