Aldrete Sol del Mar, Magee Matthew J, Friedman-Moraco Rachel J, Chan Austin W, Banks Grier G, Burd Eileen M, Kraft Colleen S
From the Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA;
Division of Epidemiology and Biostatistics, Georgia State University School of Public Health, Atlanta;
Am J Clin Pathol. 2015 Jun;143(6):895-900. doi: 10.1309/AJCP9EWI6QPVTPQY.
Polymerase chain reaction (PCR) has been shown to have an excellent sensitivity and specificity for the detection of Clostridium difficile infection (CDI). Little is known about risk factors for CDI within 14 days of an initial negative test. We sought to determine the characteristics among hospitalized patients associated with risk of short-term acquisition of CDI.
A case-control study was conducted. Cases were patients who converted from PCR negative to positive within 14 days. Each case was matched with three controls. Conditional logistic regression was used to estimate the association between patient characteristics and CDI.
Of the 30 patients in our study who had a positive PCR within 14 days of a first negative PCR (cases), 15 (50%) occurred within 7 days of the initial test. Cases had a higher proportion of intravenous vancomycin use in the previous 8 weeks (odds ratio [OR], 3.38; 95% confidence interval [CI], 1.34-8.49) and were less likely to have recent antiviral agent use (OR, 0.30; 95% CI, 0.11-0.83) compared with controls.
In hospitalized patients, treatment with intravenous vancomycin within the prior 8 weeks of a first negative PCR test for C difficile is a risk factor for short-term risk for hospital-acquired CDI. Repeat testing guidelines for C difficile PCR should take into consideration patients who may be at high risk for short-term acquisition of CDI.
聚合酶链反应（PCR）已被证明在检测艰难梭菌感染（CDI）方面具有出色的敏感性和特异性。对于初次检测为阴性后的14天内CDI的危险因素知之甚少。我们试图确定住院患者中与短期获得CDI风险相关的特征。
进行了一项病例对照研究。病例为在14天内从PCR阴性转为阳性的患者。每个病例与三个对照匹配。使用条件逻辑回归来估计患者特征与CDI之间的关联。
在我们研究的30例初次PCR阴性后14天内PCR呈阳性的患者（病例）中，15例（50%）发生在初次检测的7天内。与对照组相比，病例在过去8周内静脉使用万古霉素的比例更高（比值比[OR]，3.38；95%置信区间[CI]，1.34 - 8.49），近期使用抗病毒药物的可能性较小（OR，0.30；95% CI，0.11 - 0.83）。
在住院患者中，初次艰难梭菌PCR检测阴性前8周内接受静脉万古霉素治疗是医院获得性CDI短期风险的一个危险因素。艰难梭菌PCR的重复检测指南应考虑可能有短期获得CDI高风险的患者。
