Collins Deirdre A, Selvey Linda A, Celenza Antonio, Riley Thomas V
School of Medical and Health Sciences, Edith Cowan University, Perth, Australia.
School of Public Health, The University of Queensland, Brisbane, Australia.
Anaerobe. 2017 Dec;48:121-125. doi: 10.1016/j.anaerobe.2017.08.008. Epub 2017 Aug 12.
Clostridium difficile infection (CDI) is primarily associated with hospitalised patients, however, community-associated CDI (CA-CDI) has increased in Australia. We aimed to investigate the epidemiology and outcomes of CA-CDI cases presenting to hospital emergency departments in Western Australia (WA). A retrospective case-control study of CA-CDI cases presenting at six emergency departments in WA from July 2013 to June 2014 was performed. Clinical signs, recent medication, hospitalisations and potential risk factors for CA-CDI were investigated for cases (n = 34) and unmatched controls (n = 62) who were infected with another gastrointestinal pathogen, including Campylobacter spp., Salmonella spp., Aeromonas spp., Shigella sonnei and Escherichia coli O157. Elevated white cell count (31.3% vs 8.2%, p < 0.01), female gender (67.6% vs 41.9%, p < 0.05), age ≥65 years (41.2% vs 21.0%, p < 0.05) and antimicrobial use in the previous month (41.2% vs 11.3%, p < 0.01) were significantly more frequent among cases compared to controls. After multivariable analysis, antibiotic use (odds ratio 8.49, 95% confidence interval 2.75-26.21) and age ≥65 years (3.03, 1.05-8.75) were significantly associated with CA-CDI. Ribotype (RT) 014/020 was most common (40.7%) among 27 C. difficile isolates followed by RTs 002 (14.8%), 001, 056 and 244 (all 7.4%). CA-CDI was associated with advanced age and recent antibiotic use compared to those infected with other gastrointestinal pathogens. RT 014 has also recently been found at high prevalence in public lawn spaces, and previously RT 014 strains from humans and pigs in Australia were closely genetically related, suggesting CA-CDI may be linked with these community reservoirs.
艰难梭菌感染（CDI）主要与住院患者相关，然而，澳大利亚社区获得性艰难梭菌感染（CA-CDI）有所增加。我们旨在调查西澳大利亚州（WA）医院急诊科收治的CA-CDI病例的流行病学及转归情况。对2013年7月至2014年6月期间在西澳大利亚州6个急诊科就诊的CA-CDI病例进行了一项回顾性病例对照研究。对34例CA-CDI病例及62例未匹配的感染其他胃肠道病原体（包括弯曲杆菌属、沙门菌属、气单胞菌属、宋内志贺菌和大肠杆菌O157）的对照者，调查其临床体征、近期用药情况、住院史及CA-CDI的潜在危险因素。与对照组相比，病例组白细胞计数升高（31.3%对8.2%，p<0.01）、女性（67.6%对41.9%，p<0.05）、年龄≥65岁（41.2%对21.0%，p<0.05）及前1个月使用抗菌药物（41.2%对11.3%，p<0.01）的情况显著更常见。多变量分析后，抗生素使用（比值比8.49，95%置信区间2.75-26.21）及年龄≥65岁（3.03，1.05-8.75）与CA-CDI显著相关。在27株艰难梭菌分离株中，核糖体分型（RT）014/020最常见（40.7%），其次是RTs 002（14.8%）、001、056和244（均为7.4%）。与感染其他胃肠道病原体的患者相比，CA-CDI与高龄及近期使用抗生素有关。最近还发现RT 014在公共草坪区域的患病率很高，此前在澳大利亚，来自人类和猪的RT 014菌株在基因上密切相关，这表明CA-CDI可能与这些社区传染源有关。
