Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia.
Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia; Department of Population Medicine, College of Medicine, Qatar University, Doha, Qatar.
J Hosp Infect. 2019 Jun;102(2):157-164. doi: 10.1016/j.jhin.2019.03.001. Epub 2019 Mar 15.
Clostridium difficile infection (CDI) is the leading cause of antibiotic-associated diarrhoea with peak incidence in late winter or early autumn. Although CDI is commonly associated with hospitals, community transmission is important.
To explore potential drivers of CDI seasonality and the effect of community-based interventions to reduce transmission.
A mechanistic compartmental model of C. difficile transmission in a hospital and surrounding community was used to determine the effect of reducing transmission or antibiotic prescriptions in these settings. The model was extended to allow for seasonal antibiotic prescriptions and seasonal transmission.
Modelling antibiotic seasonality reproduced the seasonality of CDI, including approximate magnitude (13.9-15.1% above annual mean) and timing of peaks (0.7-1.0 months after peak antibiotics). Halving seasonal excess prescriptions reduced the incidence of CDI by 6-18%. Seasonal transmission produced larger seasonal peaks in the prevalence of community colonization (14.8-22.1% above mean) than seasonal antibiotic prescriptions (0.2-1.7% above mean). Reducing transmission from symptomatic or hospitalized patients had little effect on community-acquired CDI, but reducing transmission in the community by ≥7% or transmission from infants by ≥30% eliminated the pathogen. Reducing antibiotic prescription rates led to approximately proportional reductions in infections, but limited reductions in the prevalence of colonization.
Seasonal variation in antibiotic prescription rates can account for the observed magnitude and timing of C. difficile seasonality. Even complete prevention of transmission from hospitalized patients or symptomatic patients cannot eliminate the pathogen, but interventions to reduce transmission from community residents or infants could have a large impact on both hospital- and community-acquired infections.
艰难梭菌感染（CDI）是抗生素相关性腹泻的主要原因，发病高峰在冬末或初秋。尽管 CDI 通常与医院有关，但社区传播也很重要。
探索 CDI 季节性的潜在驱动因素以及减少传播的基于社区的干预措施的效果。
使用艰难梭菌在医院和周围社区传播的机制房室模型来确定在这些环境中减少传播或抗生素处方的效果。该模型扩展到允许季节性抗生素处方和季节性传播。
模拟抗生素季节性再现了 CDI 的季节性，包括幅度（高于年平均值的 13.9-15.1%）和高峰时间（抗生素高峰后 0.7-1.0 个月）。将季节性过量处方减半可将 CDI 的发病率降低 6-18%。季节性传播导致社区定植的流行率出现较大的季节性高峰（高于平均值的 14.8-22.1%），而季节性抗生素处方则导致较低的高峰（高于平均值的 0.2-1.7%）。减少来自有症状或住院患者的传播对社区获得性 CDI 影响不大，但将社区传播减少≥7%或减少来自婴儿的传播≥30%可消除病原体。减少抗生素处方率会导致感染率大致成比例减少，但对定植的流行率影响有限。
抗生素处方率的季节性变化可以解释观察到的艰难梭菌季节性的幅度和时间。即使完全预防住院患者或有症状患者的传播也不能消除病原体，但减少社区居民或婴儿传播的干预措施可能对医院和社区获得性感染产生重大影响。
