Van Esch Gretel, Van Broeck Johan, Delmée Michel, Catry Boudewijn
Scheutbos, Revalidation Centre for Psychogeriatric patients, Brussels, Belgium.
Department of Clinical Microbiology, Cliniques Universitaires Saint-Luc (UCL), Brussels, Belgium.
Arch Public Health. 2015 Apr 6;73(1):18. doi: 10.1186/s13690-015-0067-y. eCollection 2015.
Following an exceptionally high Clostridium difficile infections (CDI) incidence (Spring 2011) in a psychogeriatric long-term care facility, a bidirectional study (2009-2012) was initiated to identify determinants (retrospectively) and to assess intervention measures taken (prospectively).
For every CDI patient (de novo cases, relapses, and recurrences), a control patient (patient in the opposite room) was selected and risk factor analysis performed. Following the epidemic peak a more stringent hygienic protocol and surveillance program were implemented, as well as uniform guidelines for metronidazole and vancomycin prescription.
The nutritional state (total protein/prealbumine) significantly differed between the CDI group (poorer nutritional state at admission) and the control group, and also antibiotic use (general) could be confirmed as a risk factor. A multi-disciplinary nutritional team has been established in order to improve the nutritional balance of our patients.
Aside from stringent hygiene and antibiotic prescription stewardship, malnutrition of patients is a factor to be taken into account to contain a CDI outbreak in a long term care facility (LTCF).
在一家老年精神科长期护理机构中，艰难梭菌感染（CDI）发病率在2011年春季异常高之后，开展了一项双向研究（2009 - 2012年），以回顾性确定决定因素，并前瞻性评估所采取的干预措施。
对于每例CDI患者（新发病例、复发和再发），选择一名对照患者（对面病房的患者）并进行危险因素分析。在疫情高峰之后，实施了更严格的卫生规程和监测计划，以及甲硝唑和万古霉素处方的统一指南。
CDI组（入院时营养状况较差）和对照组之间的营养状况（总蛋白/前白蛋白）存在显著差异，并且抗生素的使用（总体）也可确认为一个危险因素。已成立了一个多学科营养团队，以改善我们患者的营养平衡。
除了严格的卫生和抗生素处方管理外，患者的营养不良也是在长期护理机构（LTCF）控制CDI暴发时需要考虑的一个因素。
