Division of Infectious Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee.
Collaborative for Healthcare Delivery Science, Medical College of Wisconsin, Milwaukee.
JAMA Netw Open. 2020 Jan 3;3(1):e1919132. doi: 10.1001/jamanetworkopen.2019.19132.
Clostridioides difficile infection is the most frequent health care-associated infection in the United States. However, exposure to this organism might occur outside the health care setting.
To examine whether exposure to environmental factors, such as livestock farms, is associated with a higher probability of being colonized with C difficile at hospital admission.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study was conducted from May 1, 2017, to June 30, 2018, at a teaching-affiliated hospital in Milwaukee, Wisconsin. All consecutive patients underwent C difficile screening using a nucleic acid amplification test at hospital admission. Data analyses were performed from July 2018 to October 2019.
The distances from patient residence to the nearest livestock farms, meat processing plants, raw materials services, and sewage facilities were measured in addition to risk factors previously evaluated in other studies.
The main outcome was a positive result on C difficile screening tests performed within 72 hours of hospital admission.
A total of 3043 patients admitted to the hospital were included in the final analysis. Of those, 1564 (51.4%) were women and 2074 (68.9%) were white, with a mean (SD) age of 62.0 (15.9) years; 978 patients (32.1%) were admitted to hematology-oncology units. At first admission, 318 patients (10.4%) were detected through testing as C difficile carriers. Multivariable logistic regression analyses were performed on a stratified sample of patients based on hematology-oncology admission status. These analyses indicated that although patients admitted to hematology-oncology units were 35% more likely to be colonized with C difficile, no significant association existed between their sociodemographic and economic characteristics or health care and environmental exposures and the likelihood of a positive C difficile test result. In contrast, among patients admitted to non-hematology-oncology units, comorbidities increased the likelihood for colonization by more than 4 times; women had 60% greater colonization than men, and a history of recent hospitalization (ie, within the preceding 6 months) increased the likelihood of colonization by 70%. Residential proximity to livestock farms were all significantly associated with a higher likelihood of a positive C difficile test result. Residential proximity to livestock farms more than doubled the probability of C difficile colonization in patients admitted to non-hematology-oncology units.
A shorter distance between residence and livestock farms was associated with C difficile colonization. Knowledge of the epidemiology of C difficile in the community surrounding the hospital is important, as it has potential implications for the incidence of hospital-onset C difficile infection.
艰难梭菌感染是美国最常见的与医疗保健相关的感染。然而，这种生物体的暴露可能发生在医疗保健环境之外。
研究接触环境因素（如牲畜养殖场）是否与入院时更有可能被艰难梭菌定植相关。
设计、地点和参与者：这是一项回顾性队列研究，于 2017 年 5 月 1 日至 2018 年 6 月 30 日在威斯康星州密尔沃基的一所教学附属医院进行。所有连续入院的患者在入院时均使用核酸扩增试验进行艰难梭菌筛查。数据分析于 2018 年 7 月至 2019 年 10 月进行。
除了其他研究中已经评估过的危险因素外，还测量了患者居住地与最近的牲畜养殖场、肉类加工厂、原材料服务和污水处理设施的距离。
主要结果是在入院后 72 小时内进行的艰难梭菌筛查检测呈阳性。
共纳入 3043 名入院患者进行最终分析。其中，1564 名（51.4%）为女性，2074 名（68.9%）为白人，平均（SD）年龄为 62.0（15.9）岁；978 名患者（32.1%）被收入血液科-肿瘤病房。初次入院时，通过检测发现 318 名（10.4%）患者为艰难梭菌携带者。对基于血液科-肿瘤病房入院状态的患者进行分层样本的多变量逻辑回归分析。这些分析表明，尽管入住血液科-肿瘤病房的患者感染艰难梭菌的可能性增加了 35%，但他们的社会人口统计学和经济特征或医疗保健和环境暴露与阳性艰难梭菌检测结果的可能性之间没有显著关联。相比之下，在非血液科-肿瘤病房住院的患者中，合并症使定植的可能性增加了 4 倍以上；女性比男性更容易定植，且最近住院（即入院前 6 个月内）会使定植的可能性增加 70%。居住地与牲畜养殖场的距离均与阳性艰难梭菌检测结果的可能性显著相关。与非血液科-肿瘤病房住院患者相比，居住地与牲畜养殖场的距离越近，患者艰难梭菌定植的可能性就越高。了解医院周围社区中艰难梭菌的流行病学情况很重要，因为这可能对医院获得性艰难梭菌感染的发生率产生影响。
