National Reference Laboratory for Clostridium difficile, Paris, France; Department of Bacteriology, AP-HP, Saint-Antoine Hospital, Hôpitaux Universitaires de l'Est Parisien, Paris, France; INSERM 1139, Université Paris Descartes, Paris, France.
Laboratory of Chemin Vert, Paris, France.
Clin Microbiol Infect. 2019 May;25(5):588-594. doi: 10.1016/j.cmi.2018.12.024. Epub 2019 Jan 4.
Reported rates of community-acquired Clostridium difficile infections (CDIs) have been increasing. However, the true burden of the disease in general practice is unknown in France. Our objective was to determine the incidence of toxigenic C. difficile carriage and the percentage of stool samples prescribed by general practitioners (GPs) which contained free C. difficile toxins.
During an 11-month period, all stool samples submitted for any enteric pathogen detection to 15 different private laboratories in Paris and the surrounding areas were tested for C. difficile, irrespective of the GPs' request. A clinical questionnaire was completed for each patient. Stool samples were screened using a rapid simultaneous glutamate dehydrogenase and toxins A/B detection test: any positive result (glutamate dehydrogenase or toxin) was further confirmed by the stool cytotoxicity assay (CTA) on MRC-5 cells and by toxigenic culture (TC) at a central laboratory. The C. difficile isolates were characterized by PCR ribotyping.
A total of 2541 patients (1295 female, 1246 male) were included. The incidences of patients with a positive toxigenic culture and a positive CTA were 3.27% (95% CI 2.61%-4.03%) and 1.81% (95% CI 1.33%-2.41%), respectively. GPs requested C. difficile testing in only 12.93% of the stool samples, detecting 52.30% of all TC-positive patients. The 83 toxigenic C. difficile strains belonged to 36 different PCR ribotypes.
Toxigenic C. difficile carriage is frequent in general practice but remains under-recognized. It may affect young patients without previous antimicrobial therapy or hospitalization.
社区获得性艰难梭菌感染（CDI）的报告发病率一直在上升。然而，在法国，一般实践中疾病的真实负担尚不清楚。我们的目的是确定产毒艰难梭菌携带的发生率以及一般从业者（GP）规定的粪便样本中包含游离艰难梭菌毒素的百分比。
在 11 个月的时间里，巴黎和周边地区的 15 家不同私人实验室提交的所有粪便样本均进行了艰难梭菌检测，无论 GP 的要求如何。为每位患者完成了一份临床问卷。粪便样本使用快速同时谷氨酸脱氢酶和毒素 A/B 检测法进行筛选：任何阳性结果（谷氨酸脱氢酶或毒素）均通过 MRC-5 细胞粪便细胞毒性测定（CTA）和中心实验室的产毒培养（TC）进一步确认。艰难梭菌分离株通过 PCR 核糖体分型进行鉴定。
共纳入 2541 名患者（1295 名女性，1246 名男性）。产毒培养阳性和 CTA 阳性患者的发生率分别为 3.27%（95%CI 2.61%-4.03%）和 1.81%（95%CI 1.33%-2.41%）。只有 12.93%的粪便样本要求进行艰难梭菌检测，检测出所有 TC 阳性患者的 52.30%。83 株产毒艰难梭菌菌株属于 36 种不同的 PCR 核糖体型。
产毒艰难梭菌在一般实践中很常见，但仍未得到充分认识。它可能影响没有先前使用抗生素治疗或住院治疗的年轻患者。
