Bauer Karri A, Johnston Jessica E W, Wenzler Eric, Goff Debra A, Cook Charles H, Balada-Llasat Joan-Miquel, Pancholi Preeti, Mangino Julie E
Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Department of Internal Medicine, Division of Infectious Diseases, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Anaerobe. 2017 Dec;48:1-6. doi: 10.1016/j.anaerobe.2017.06.009. Epub 2017 Jun 21.
Studies are conflicting regarding the association of the North American pulsed-field gel electrophoresis type 1 (NAP1) strain in Clostridium difficile infection (CDI) and outcomes. We evaluated the association of NAP1 with healthcare-associated CDI disease severity, mortality, and recurrence at our academic medical center.
Healthcare-associated CDI cases were identified from November 1, 2011 through January 31, 2013. Multivariable regression models were used to evaluate the associations of NAP1 with severe disease (based on the Hines VA severity score index), mortality, and recurrence.
Among 5424 stool specimens submitted to the Clinical Microbiology Laboratory, 292 (5.4%) were positive for C. difficile by polymerase chain reaction (PCR) on or after hospital day 4; 70 (24%) of these specimens also tested positive for NAP1. During the study period, 247 (85%) patients had non-severe disease and 45 (15%) patients had severe disease. Among patients with non-severe disease, 65 (26%) had NAP1 and among patients with severe disease, 5 (11%) had NAP1. After controlling for potential confounders, NAP1 was not associated with an increased likelihood of severe disease (adjusted odds ratio [aOR] = 0.35; 95% confidence interval [CI], 0.13-0.93), in-hospital mortality (aOR = 1.02; 95% CI, 0.53-1.96), or recurrence (aOR = 1.16, 95% CI, 0.36-3.77).
The NAP1 strain did not increase disease severity, mortality, or recurrence in this study, although the incidence of NAP1-positive healthcare associated-CDI was low. The role of strain typing in outcomes and treatment selection in patients with healthcare-associated CDI remains uncertain.
关于艰难梭菌感染（CDI）中北美脉冲场凝胶电泳1型（NAP1）菌株与预后的关联，各项研究结果存在冲突。我们在我们的学术医疗中心评估了NAP1与医疗保健相关CDI疾病严重程度、死亡率及复发之间的关联。
确定2011年11月1日至2013年1月31日期间医疗保健相关的CDI病例。采用多变量回归模型评估NAP1与严重疾病（基于海因斯退伍军人管理局严重程度评分指数）、死亡率及复发之间的关联。
在提交至临床微生物实验室的5424份粪便标本中，292份（5.4%）在住院第4天及以后通过聚合酶链反应（PCR）检测艰难梭菌呈阳性；其中70份（24%）标本NAP1检测也呈阳性。在研究期间，247例（85%）患者患有非严重疾病，45例（15%）患者患有严重疾病。在非严重疾病患者中，65例（26%）为NAP1，在严重疾病患者中，5例（11%）为NAP1。在控制潜在混杂因素后，NAP1与严重疾病发生可能性增加（调整优势比[aOR]=0.35；95%置信区间[CI]，0.13 - 0.93）、住院死亡率（aOR = 1.02；95% CI，0.53 - 1.96）或复发（aOR = 1.16，95% CI，0.36 - 3.77）均无关联。
尽管NAP1阳性的医疗保健相关CDI发生率较低，但在本研究中，NAP1菌株并未增加疾病严重程度、死亡率或复发率。菌株分型在医疗保健相关CDI患者的预后及治疗选择中的作用仍不确定。
