Behar Laura, Chadwick David, Dunne Angela, Jones Christopher I, Proctor Claire, Rajkumar Chakravarthi, Sharratt Paula, Stanley Philip, Whiley Angela, Wilks Mark, Llewelyn Martin J
Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton, East Sussex, BN2 5BE, United Kingdom.
The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, United Kingdom.
J Infect. 2017 Jul;75(1):20-25. doi: 10.1016/j.jinf.2017.04.006. Epub 2017 Apr 21.
To establish risk factors for Clostridium difficile colonization among hospitalized patients in England.
Patients admitted to elderly medicine wards at three acute hospitals in England were recruited to a prospective observational study. Participants were asked to provide a stool sample as soon as possible after enrolment and then weekly during their hospital stay. Samples were cultured for C. difficile before ribotyping and toxin detection by PCR. A multivariable logistic regression model of risk factors for C. difficile colonization was fitted from univariable risk factors significant at the p < 0.05 level.
410/727 participants submitted ≥1 stool sample and 40 (9.8%) carried toxigenic C. difficile in the first sample taken. Ribotype 106 was identified three times and seven other ribotypes twice. No ribotype 027 strains were identified. Independent predictors of colonization were previous C. difficile infection (OR 4.53 (95% C.I. 1.33-15.48) and malnutrition (MUST score ≥2) (OR 3.29 (95% C.I. 1.47-7.35)). Although C. difficile colonised patients experienced higher 90-day mortality, colonization was not an independent risk for death.
In a non-epidemic setting patients who have previously had CDI and have a MUST score of ≥2 are at increased risk of C. difficile colonization and could be targeted for active surveillance to prevent C. difficile transmission.
确定英格兰住院患者艰难梭菌定植的危险因素。
招募英格兰三家急症医院老年医学科病房收治的患者进行一项前瞻性观察性研究。参与者在入组后尽快提供一份粪便样本，然后在住院期间每周提供一次。样本在进行核糖体分型和PCR毒素检测之前先培养艰难梭菌。根据p<0.05水平有统计学意义的单变量危险因素拟合艰难梭菌定植危险因素的多变量逻辑回归模型。
410/727名参与者提交了≥1份粪便样本，40名（9.8%）在采集的第一份样本中携带产毒素艰难梭菌。鉴定出3次核糖体分型106，其他7种核糖体分型各鉴定出2次。未鉴定出核糖体分型027菌株。定植的独立预测因素为既往艰难梭菌感染（比值比4.53（95%置信区间1.33 - 15.48））和营养不良（营养不良通用筛查工具评分≥2）（比值比3.29（95%置信区间1.47 - 7.35））。虽然艰难梭菌定植患者的90天死亡率较高，但定植并非死亡的独立危险因素。
在非流行环境中，既往有艰难梭菌感染且营养不良通用筛查工具评分≥2的患者艰难梭菌定植风险增加，可作为主动监测的目标以预防艰难梭菌传播。
