Internal Medicine Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy.
Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Eur J Intern Med. 2018 Aug;54:21-26. doi: 10.1016/j.ejim.2018.03.015. Epub 2018 Apr 9.
To describe clinical characteristics and outcome of Clostridium difficile infection (CDI) patients in Internal Medicine, to identify ribotypes (RTs); to evaluate the association between RT and patient clinical characteristics and report outcome.
One year prospective cohort study. Clinical data, Barthel Index (BI) and outcomes were collected for all inpatients suffering from CDI (n = 148) in hospital wards in Northern Italy. 84 fecal samples were analysed for molecular typing.
12 RTs were identified, predominantly RT018 (42.9%, n = 36/84) and RT356/607 (40.5%, n = 34/84). Patients with dementia were more frequent among those infected by RT018 [55.6% (n = 20/36) vs. 32.4% (n = 11/34), p = 0.05]. The median BI score of patients with RT018 was lower than BI score of patients with RT356/607 [10 (IQR 0-32) vs. 15 (IQR 5-50), p = 0.06]. RT018 infection was associated to higher levels of C-reactive protein [7.2 mg/dl (IQR 4.1-14.7) vs. 4.0 mg/dl (IQR 2.2-6.8), p = 0.01] and white blood cells ≥15,000/dl [33.3% (n = 12/36) vs. 14.7% (n = 5/34) of patients, p = 0.07]. Higher mortality was noted among RT018 infected patients. We found a continuous mortality increase according to the ATLAS score.
Our results confirm that RT018 and RT356/607 are the two major RTs causing CDI in older patients with a high degree of disability in Northern Italy and RT018 is associated with more serious outcomes.
描述内科住院患者艰难梭菌感染（CDI）的临床特征和结局，鉴定核糖型（RT）；评估 RT 与患者临床特征的相关性，并报告结局。
这是一项为期 1 年的前瞻性队列研究。在意大利北部的医院病房中，对所有患有 CDI（n=148）的住院患者收集临床数据、巴氏指数（BI）和结局。对 84 份粪便样本进行了分子分型分析。
鉴定出 12 种 RT，主要为 RT018（42.9%，n=36/84）和 RT356/607（40.5%，n=34/84）。感染 RT018 的患者中痴呆更为常见[55.6%（n=20/36） vs. 32.4%（n=11/34），p=0.05]。感染 RT018 的患者 BI 评分中位数低于感染 RT356/607 的患者[10（IQR 0-32）vs. 15（IQR 5-50），p=0.06]。RT018 感染与更高的 C 反应蛋白水平相关[7.2mg/dl（IQR 4.1-14.7）vs. 4.0mg/dl（IQR 2.2-6.8），p=0.01]和白细胞计数≥15,000/dl[33.3%（n=12/36）vs. 14.7%（n=5/34），p=0.07]。RT018 感染患者的死亡率更高。我们发现，根据 ATLAS 评分，死亡率呈连续增加。
我们的研究结果证实，RT018 和 RT356/607 是导致意大利北部老年、高残疾患者 CDI 的两种主要 RT，且 RT018 与更严重的结局相关。
