Ahmed Abeera, Ikram Aamer, Sabir Nargis, Zaman Gohar, Gardeezi Adeel, Satti Luqman
Department of Pathology, Combined Military Hospital, Karachi, Pakistan.
National Institute of Health (NIH), Islamabad, Pakistan.
J Pak Med Assoc. 2022 Apr;72(4):610-615. doi: 10.47391/JPMA.0461.
To evaluate the epidemiology of clostridioides difficile infections and colonisation in a tertiary-care setting.
The cross-sectional study was conducted at the Combined Military Hospital, Rawalpindi, Pakistan, from June 1, 2017, to October 31, 2019, and comprised adult patients admitted in high-risk units of the hospital for any disease experiencing watery stools after 48 hours of hospital admission and passing more than 3 stools per day with no other recognised aetiology. Stool samples of the participants, diagnosed with antibiotic associated diarrhoea, were submitted for glutamate dehydrogenase antigen assay and clostridioides toxin A/B assay detected by enzyme-linked immunosorbent assay and clostridioides difficile toxin gene detection by polymerase chain reaction. Clostridium difficile-associated diarrhoea was diagnosed by a positive toxin assay or polymerase chain reaction. Data was analysed using SPSS25.
Of the 715 subjects, 322(45%) were males and 393(55%) were females. The overall mean age was 56.64±8.57 years, and 488(68.3%) were aged <60 years, while 227(31.7%) were aged >60 years. The incidence of clostridioides difficile-associated diarrhoea was found in 10(1.4%) patients and was highest in oncology unit 3(4.3%). No positive case was detected from the high dependency unit and the surgical ward. All the10(1.4%) positive cases were on >2 antibiotics with a combination of oral vancomycin and intravenous metronidazole. Mortality rate was significantly higher in the positive cases compared to those with clostridioides difficile colonisation (p<0.05).
The incidence of clostridioides difficile-associated diarrhoea was found to be low.
评估三级医疗环境中艰难梭菌感染和定植的流行病学情况。
这项横断面研究于2017年6月1日至2019年10月31日在巴基斯坦拉瓦尔品第的联合军事医院进行，纳入因任何疾病入住医院高危科室的成年患者，这些患者在入院48小时后出现水样便，且每天排便超过3次，无其他已知病因。对诊断为抗生素相关性腹泻的参与者的粪便样本进行谷氨酸脱氢酶抗原检测、酶联免疫吸附法检测艰难梭菌毒素A/B以及聚合酶链反应检测艰难梭菌毒素基因。通过毒素检测阳性或聚合酶链反应诊断艰难梭菌相关性腹泻。使用SPSS25软件进行数据分析。
715名受试者中，322名（45%）为男性，393名（55%）为女性。总体平均年龄为56.64±8.57岁，488名（68.3%）年龄<60岁，227名（31.7%）年龄>60岁。10名（1.4%）患者被发现患有艰难梭菌相关性腹泻，在肿瘤科3发病率最高（4.3%）。在高依赖病房和外科病房未检测到阳性病例。所有10名（1.4%）阳性病例均使用了>2种抗生素，并联合口服万古霉素和静脉注射甲硝唑。与艰难梭菌定植患者相比，阳性病例的死亡率显著更高（p<0.05）。
发现艰难梭菌相关性腹泻的发病率较低。
