Jolivet Sarah, Couturier Jeanne, Grohs Patrick, Vilfaillot Aurélie, Zahar Jean-Ralph, Frange Pierre, Casetta Anne, Moulin Véronique, Lawrence Christine, Baune Patricia, Bourgeois Cléo, Bouffier Axel, Laussucq Claudine, Sienzonit Lydia, Picard Simon, Podglajen Isabelle, Kassis-Chikhani Najiby, Barbut Frédéric
Unité de prévention du risque infectieux, Hôpital Saint Antoine, Paris, France.
Laboratoire de microbiologie de l'environnement, Hôpital Saint Antoine, Paris, France.
Front Med (Lausanne). 2023 Jul 19;10:1221363. doi: 10.3389/fmed.2023.1221363. eCollection 2023.
infection (CDI) incidence has increased over the last 20 years. Studies suggest that asymptomatic carriers may be an important reservoir of in healthcare settings. We conducted a point prevalence study to estimate the toxigenic asymptomatic carriage rate and the associated risk factors in patients >3 years old. Between September 16, 2019 and January 15, 2020, all patients hospitalized in 11 healthcare facilities in the Paris urban area were included in the study. They were screened on the day of the survey for toxigenic carriage by rectal swab and interviewed. Isolates were characterized by PCR ribotyping and multiplex PCR targeting toxin genes. A logistic regression model was used to determine the risk factors associated with toxigenic asymptomatic carriage using uni- and multivariate analysis in the subpopulation of patients >3 years old. During the study period, 2,389 patients were included and screened. The median age was 62 years (interquartile range 35-78 years) and 1,153 were male (48.3%). Nineteen patients had a previous CDI (0.9%). Overall, 185/2389 patients were positive for (7.7%), including 93 toxigenic strains (3.9%): 77 (82.8%) were asymptomatic (prevalence 3.2%) whereas 12 (12.9%) were diarrheic. Prevalences of toxigenic were 3.5% in patients >3 years old and 7.0% in ≤3 years old subjects, respectively. Toxigenic strains mainly belonged to PCR ribotypes 106 ( = 14, 15.0%), 014 ( = 12, 12.9%), and 020 ( = 10, 10.8%). Among toxigenic strains, 6 (6.4%) produced the binary toxin. In multivariate analysis, two factors were positively associated with toxigenic asymptomatic carriage in patients >3 years old: multidrug-resistant organisms co-carriage [adjusted Odd Ratio (aOR) 2.3, CI 95% 1.2-4.7, = 0.02] and previous CDI (aOR 5.8, CI 95% 1.2-28.6, = 0.03). Conversely, consumption of raw milk products were associated with reduced risk of toxigenic colonization (aOR 0.5, CI 95% 0.2-0.9, = 0.01). We showed that there was a low prevalence of asymptomatic toxigenic carriage in hospitalized patients. Consumption of raw milk prevents toxigenic colonization, probably due to the barrier effect of milk-associated bacteria.
艰难梭菌感染（CDI）发病率在过去20年中有所上升。研究表明，无症状携带者可能是医疗机构中艰难梭菌的重要储存宿主。我们进行了一项现患率研究，以估计3岁以上患者中产毒艰难梭菌无症状携带率及相关危险因素。在2019年9月16日至2020年1月15日期间，巴黎市区11家医疗机构的所有住院患者纳入研究。在调查当天通过直肠拭子对他们进行产毒艰难梭菌携带情况筛查并进行访谈。分离株通过PCR核糖体分型和靶向毒素基因的多重PCR进行鉴定。在3岁以上患者亚组中，使用单因素和多因素分析的逻辑回归模型来确定与产毒艰难梭菌无症状携带相关的危险因素。研究期间，纳入并筛查了2389例患者。中位年龄为62岁（四分位间距35 - 78岁），男性1153例（48.3%）。19例患者既往有CDI（0.9%）。总体而言，2389例患者中185例艰难梭菌检测呈阳性（7.7%），其中93株为产毒菌株（3.9%）：77株（82.8%）无症状（携带率3.2%），而12株（12.9%）有腹泻症状。产毒艰难梭菌在3岁以上患者中的携带率为3.5%，在≤3岁受试者中为7.0%。产毒菌株主要属于PCR核糖体分型106（n = 14，15.0%）、014（n = 12，12.9%）和020（n = 10，10.8%）。在产毒菌株中，6株（6.4%）产生二元毒素。多因素分析显示，3岁以上患者中产毒艰难梭菌无症状携带与两个因素呈正相关：多重耐药菌共携带[调整后比值比（aOR）2.3，95%可信区间1.2 - 4.7, P = 0.02]和既往CDI（aOR 5.8，95%可信区间1.2 - 28.6, P = 0.03）。相反，食用生鲜奶制品与产毒艰难梭菌定植风险降低相关（aOR 0.5，95%可信区间0.2 - 0.9, P = 0.01）。我们发现住院患者中产毒艰难梭菌无症状携带率较低。食用生鲜奶制品可预防产毒艰难梭菌定植，可能是由于与牛奶相关细菌的屏障作用。
