Shaffer Seth R, Nugent Zoann, Walkty Andrew, Yu B Nancy, Lix Lisa M, Targownik Laura E, Bernstein Charles N, Singh Harminder
Internal Medicine (Shaffer, Nugent, Walkty, Bernstein, Singh), University of Manitoba, Winnipeg, Man.; Inflammatory Bowel Disease Centre (Shaffer), University of Chicago Medicine, Chicago, Ill.; CancerCare Manitoba, Research Institute (Nugent, Singh); Community Health Sciences (Yu, Lix, Singh), University of Manitoba, Winnipeg, Man.; Division of Epidemiology and Population Health (Yu), BC Centre for Excellence in HIV/AIDS, Vancouver, BC; Division of Gastroenterology (Targownik), Mount Sinai Hospital, University of Toronto, Toronto, Ont.
CMAJ Open. 2020 Nov 16;8(4):E737-E746. doi: 10.9778/cmajo.20190191. Print 2020 Oct-Dec.
Many previous studies of infection (CDI) epidemiology have used hospital discharge data codes, which can have limited accuracy. We used a data set of laboratory-confirmed cases of CDI in the province of Manitoba, Canada, to describe the epidemiology of CDI over a decade.
We conducted a population-based historical cohort study using Manitoba Health's population-wide laboratory-based CDI data set linked to administrative health databases. All individuals living in Manitoba and experiencing a CDI episode between 2005 and 2015 were included ( = 8471) and followed up from CDI diagnosis. We assessed time trends of CDI, incidence and predictors of recurrence and severe outcomes, and health care encounters after CDI diagnosis. CDI episodes were stratified by community versus hospital site of acquiring CDI.
Between 2005 and 2009, overall CDI diagnoses decreased by an average of 12.6% per year (95% confidence interval [CI] -4.4 to -20.0), with no statistically significant change from 2010 to 2015. In stratified analysis, incident and recurrent CDI had a similar decrease in the initial study time period and then stabilized. The proportion of community-associated CDI cases increased by an average of 4.8% per year (95% CI 2.8 to 6.8) during the study period. CDI acquired in a health care facility had a higher recurrence rate and more severe outcomes. Recurrence of CDI increased the likelihood of admission to hospital.
Between 2005 and 2015, the rates of overall laboratory-confirmed CDI, incident CDI, recurrent CDI and severe outcomes following CDI initially decreased before stabilizing, and an increasing proportion of CDI cases were community-associated. There is an increasing need to test for CDI among outpatients with diarrhea and to increase efforts to prevent recurrent CDI.
既往许多艰难梭菌感染（CDI）流行病学研究使用医院出院数据编码，其准确性可能有限。我们使用加拿大曼尼托巴省实验室确诊的CDI病例数据集来描述十年间CDI的流行病学特征。
我们进行了一项基于人群的历史性队列研究，使用曼尼托巴省卫生部门基于人群的实验室确诊CDI数据集，并与行政卫生数据库相链接。纳入2005年至2015年间居住在曼尼托巴省且发生过CDI发作的所有个体（n = 8471），自CDI诊断起进行随访。我们评估了CDI的时间趋势、复发和严重结局的发生率及预测因素，以及CDI诊断后的医疗接触情况。CDI发作按获得CDI的社区与医院地点进行分层。
2005年至2009年间，总体CDI诊断每年平均下降12.6%（95%置信区间[CI] -4.4至-20.0），2010年至2015年间无统计学显著变化。在分层分析中，初发和复发性CDI在初始研究时间段内有类似下降，然后趋于稳定。在研究期间，社区相关性CDI病例比例每年平均增加4.8%（95% CI 2.8至6.8）。在医疗机构获得的CDI复发率更高，结局更严重。CDI复发增加了住院的可能性。
2005年至2015年间，总体实验室确诊的CDI、初发CDI、复发性CDI及CDI后的严重结局发生率最初下降，之后趋于稳定，且社区相关性CDI病例的比例不断增加。对腹泻门诊患者进行CDI检测的需求日益增加，同时需要加大预防CDI复发的力度。
