Kamboj Mini, Sheahan Anna, Sun Janet, Taur Ying, Robilotti Elizabeth, Babady Esther, Papanicolaou Genovefa, Jakubowski Ann, Pamer Eric, Sepkowitz Kent
1Infection Control,Department of Medicine,Memorial Sloan Kettering Cancer Center,New York,New York.
2Infectious Disease Service,Department of Medicine,Memorial Sloan Kettering Cancer Center,New York,New York.
Infect Control Hosp Epidemiol. 2016 Jan;37(1):8-15. doi: 10.1017/ice.2015.237. Epub 2015 Oct 21.
OBJECTIVE To determine the role of unit-based transmission that accounts for cases of early Clostridium difficile infection (CDI) during hospitalization for allogeneic stem cell transplant. SETTING Stem cell transplant unit at a tertiary care cancer center. METHODS Serially collected stool from patients admitted for transplant was screened for toxigenic C. difficile through the hospital stay and genotyping was performed by multilocus sequence typing. In addition, isolates retrieved from cases of CDI that occurred in other patients hospitalized on the same unit were similarly characterized. Transmission links were established by time-space clustering of cases and carriers of shared toxigenic C. difficile strains. RESULTS During the 27-month period, 1,099 samples from 264 patients were screened, 69 of which had evidence of toxigenic C. difficile; 52 patients developed CDI and 17 were nonsymptomatic carriers. For the 52 cases, 41 had evidence of toxigenic C. difficile on the first study sample obtained within a week of admission, among which 22 were positive within the first 48 hours. A total of 24 sequence types were isolated from this group; 1 patient had infection with the NAP1 strain. A total of 11 patients had microbiologic evidence of acquisition; donor source could be established in half of these cases. CONCLUSIONS Most cases of CDI after stem cell transplant represent delayed onset disease in nonsymptomatic carriers. Transmission on stem cell transplant unit was confirmed in 19% of early CDI cases in our cohort with a probable donor source established in half of the cases.
目的 确定在异基因干细胞移植住院期间基于病房的传播在早期艰难梭菌感染（CDI）病例中的作用。
背景 一家三级护理癌症中心的干细胞移植病房。
方法 对因移植入院患者连续采集的粪便在住院期间进行产毒艰难梭菌筛查，并通过多位点序列分型进行基因分型。此外，对在同一病房住院的其他患者发生的CDI病例中分离出的菌株进行类似特征分析。通过共享产毒艰难梭菌菌株的病例和携带者的时空聚集建立传播联系。
结果 在27个月期间，对264例患者的1099份样本进行了筛查，其中69份有产毒艰难梭菌感染证据；52例患者发生CDI，17例为无症状携带者。对于这52例病例，41例在入院一周内获得的首次研究样本中有产毒艰难梭菌感染证据，其中22例在最初48小时内呈阳性。从该组中共分离出24种序列类型；1例患者感染了NAP1菌株。共有11例患者有微生物学证据表明获得了感染；其中一半病例可确定供体来源。
结论 干细胞移植后大多数CDI病例代表无症状携带者的迟发性疾病。在我们的队列中，19%的早期CDI病例证实了干细胞移植病房内的传播，其中一半病例可能确定了供体来源。
