Toho University School of Medicine, Department of Microbiology and Infectious Diseases, 5-21-16, Omori-Nishi Ota-ku, Tokyo 143-8530, Japan.
Den-en-chofu Central Hospital, Department of General Medicine, 2-43-1, Den-en-chofu, Ota-ku, Tokyo 145-0071, Japan.
Anaerobe. 2022 Aug;76:102607. doi: 10.1016/j.anaerobe.2022.102607. Epub 2022 Jul 2.
Clostridioides difficile infection (CDI) burden is not well-characterized in Japan. Therefore, we conducted a population-based, hospitalized CDI incidence study, compared the results with standard-of-care (SOC) CDI testing, and generalized the results for nationwide incidence estimates.
Surveillance identified inpatients ≥50 years-of-age with diarrhea in nine Tokyo hospitals from December 17, 2018-March 30, 2020. A CDI case was defined as a patient with a PCR-positive/cell cytotoxicity neutralization assay (CCNA)-positive stool or a PCR-positive stool and pseudomembranous colitis (PMC). Incidence estimates were adjusted for the hospitalization share of participating hospitals and, in the sensitivity analysis, for missing CDI test results. SOC specimen collection and CDI testing occurred independently.
Surveillance during 318 840 patient-days identified 4633 inpatients with diarrhea. Sixty-three CDI cases were identified; 11 (17·5%) had PMC, eight (12·7%) recurrent CDI, and nine (14·3%) died. The hospitalized CDI incidence was 97/100 000 population per year (PPY) in persons ≥50 years-of-age and, in the sensitivity analysis, 324/100 000 PPY. The incidence was 170 and 481/100 000 PPY in persons ≥65 and ≥85 years-of-age, respectively; these estimates increased to 569 and 1609/100 000 PPY in the sensitivity analysis, respectively. There were 12 primary SOC CDI cases in persons ≥50 years-of-age (18/100 000 PPY).
The CDI incidence was high in older adults, with severe clinical consequences. SOC specimen collection and testing under-estimated CDI burden. There are >57 000 hospitalized CDI cases per year in Japan in persons ≥50 years-of-age. Public health interventions are needed to reduce the CDI burden in Japan.
艰难梭菌感染（CDI）在日本的负担情况尚未得到充分描述。因此，我们进行了一项基于人群的住院 CDI 发病率研究，将结果与标准护理（SOC）CDI 检测进行了比较，并对全国发病率估计值进行了推广。
从 2018 年 12 月 17 日至 2020 年 3 月 30 日，在东京的九家医院对≥50 岁的住院腹泻患者进行了监测。CDI 病例的定义为 PCR 阳性/细胞细胞毒性中和试验（CCNA）阳性粪便或 PCR 阳性粪便和假膜性结肠炎（PMC）的患者。发病率估计值根据参与医院的住院分担率进行了调整，在敏感性分析中，还根据缺失的 CDI 检测结果进行了调整。SOC 标本采集和 CDI 检测是独立进行的。
在 318 840 个患者日的监测中，发现了 4633 名腹泻住院患者。共发现 63 例 CDI 病例，其中 11 例（17.5%）患有 PMC，8 例（12.7%）为复发性 CDI，9 例（14.3%）死亡。≥50 岁人群的住院 CDI 发病率为 97/100000 人口/年（PPY），在敏感性分析中为 324/100000 PPY。≥65 岁和≥85 岁人群的发病率分别为 170 和 481/100000 PPY；在敏感性分析中，这些估计值分别增加到 569 和 1609/100000 PPY。≥50 岁人群中有 12 例 SOC 初诊 CDI 病例（18/100000 PPY）。
老年人群 CDI 发病率较高，且临床后果严重。SOC 标本采集和检测低估了 CDI 的负担。在≥50 岁的人群中，日本每年有超过 57000 例住院 CDI 病例。需要采取公共卫生干预措施来降低日本的 CDI 负担。
