Western Australia Adult Cystic Fibrosis Centre, Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Queen Elizabeth II Medical Centre, Nedlands, WA, Australia; School of Biomedical Sciences, Faculty of Health and Medical Sciences, The University of Western Australia, Queen Elizabeth II Medical Centre, Nedlands, WA, Australia; Institute for Respiratory Health, The Harry Perkins Institute of Medical Research, Queen Elizabeth II Medical Centre, Nedlands, WA, Australia.
School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.
J Hosp Infect. 2021 Jul;113:44-51. doi: 10.1016/j.jhin.2021.03.018. Epub 2021 Mar 26.
Little is known about Clostridioides difficile infection (CDI) in patients with cystic fibrosis (CF). The aim of this study was to investigate the prevalence, molecular epidemiology and risk factors for CDI in asymptomatic and symptomatic adults with CF in Western Australia.
Faecal samples from symptomatic and asymptomatic patients were prospectively collected and tested for the presence of C. difficile by toxigenic culture. Ribotyping was performed by established protocols. Logistic regression analysis was performed to analyse the risk factors for C. difficile colonization and infection. Extensive environmental sampling was performed within the CF clinic in Perth.
The prevalence rates of asymptomatic toxigenic and non-toxigenic C. difficile colonization were 30% (14/46 patients) and 24% (11/46 patients), respectively. Fifteen ribotypes (RTs) of C. difficile were identified, of which non-toxigenic RT 039 was the most common. Among the symptomatic patients, the prevalence of toxigenic CDI was 33% (11/33 patients). Impaired glucose tolerance/diabetes mellitus and duration of intravenous antibiotic use in the past 12 months were significantly associated with increased risk of asymptomatic toxigenic C. difficile carriage and CDI. A trend towards higher CF transmembrane conductance regulator modulator treatment was observed in the CDI group. Extensive environmental sampling showed no evidence of toxigenic C. difficile contamination within the CF clinic.
A high prevalence of asymptomatic carriage of toxigenic C. difficile was observed in adults with CF, comparable with that observed in the symptomatic CF population. There was no evidence of direct person-to-person transmission.
关于囊性纤维化（CF）患者中艰难梭菌感染（CDI）的信息知之甚少。本研究的目的是调查西澳大利亚无症状和有症状 CF 成人中 CDI 的流行率、分子流行病学和危险因素。
前瞻性收集有症状和无症状患者的粪便样本，并通过产毒培养检测 C. difficile 的存在。采用既定方案进行核糖体分型。使用逻辑回归分析来分析艰难梭菌定植和感染的危险因素。在珀斯的 CF 诊所内进行了广泛的环境采样。
无症状产毒和非产毒艰难梭菌定植的流行率分别为 30%（46 例患者中的 14 例）和 24%（46 例患者中的 11 例）。鉴定出 15 种艰难梭菌核糖体型（RT），其中非产毒 RT039 最为常见。在有症状患者中，产毒 CDI 的流行率为 33%（33 例患者中的 11 例）。葡萄糖耐量受损/糖尿病和过去 12 个月内静脉使用抗生素的时间与无症状产毒艰难梭菌定植和 CDI 的风险增加显著相关。在 CDI 组中，CF 跨膜电导调节剂调节剂治疗的趋势更高。广泛的环境采样未显示 CF 诊所内存在产毒艰难梭菌污染的证据。
在 CF 成人中观察到无症状产毒艰难梭菌定植的高流行率，与有症状 CF 人群中的流行率相当。没有证据表明直接的人际传播。
