Walker K J, Gilliland S S, Vance-Bryan K, Moody J A, Larsson A J, Rotschafer J C, Guay D R
College of Pharmacy, University of Minnesota, Minneapolis.
J Am Geriatr Soc. 1993 Sep;41(9):940-6. doi: 10.1111/j.1532-5415.1993.tb06759.x.
To determine the period prevalence of Clostridium difficile disease and asymptomatic carriage in the residents of long-term care facilities (LTCF) and to characterize the risk factors for colonization or associated disease.
Period prevalence survey.
Two long-term care facilities in St. Paul, MN.
Specimens were collected from 225 LTCF residents.
The dependent variable was the culture result for C. difficile, which was isolated and identified using selective culture media and a commercial anaerobe identification kit. Tissue culture assay was used to detect the ability of each C. difficile isolate to produce toxin. Independent variables (including gender, age, race, current medical diagnoses, severity of underlying disease, case mix, current clinical symptoms, current medications, antibiotic use within 4 weeks prior to specimen procurement, and other pertinent history) were obtained from the current medical record of each participant.
Of 225 stool cultures that were obtained, 16 (7.1%) were positive for C. difficile. None of the residents with a positive culture was symptomatic. History of nosocomial infection and the use of antibiotics in general, cephalosporins, trimethoprim/sulfamethoxazole (TMP/SMX), and histamine-2 blockers were significantly associated with positive C. difficile culture (P < or = 0.05) by univariate analyses. Trends towards significance (0.05 < 0.10) were noted for narcotic use, previous hospitalization, LTCF, and non-insulin-dependent diabetes mellitus. Logistic regression analysis revealed significant, independent predictors of positive culture: antibiotic use in general (P = 0.028; relative risk = 3.31), histamine-2 antagonist use (P = 0.038; relative risk = 3.27), cephalosporin use (P = 0.038; relative risk = 4.66), and TMP/SMX use (P = 0.007; relative risk = 8.45).
The use of antibiotics, particularly cephalosporins and TMP/SMX, is a significant risk factor for asymptomatic carriage of C. difficile in long-term care facilities. The use of H-2 blockers was also a significant risk factor for carriage; however, this finding has not been reported previously and should be confirmed by independent studies. These medications should be used judiciously in the LTCF population. When diarrheal diseases are encountered in LTCF residents, a high index of suspicion for C. difficile infection should be maintained and the appropriate diagnostic and therapeutic measures taken.
确定长期护理机构（LTCF）居民中艰难梭菌病和无症状携带的期间患病率，并描述定植或相关疾病的危险因素。
期间患病率调查。
明尼苏达州圣保罗的两家长期护理机构。
从225名LTCF居民中采集标本。
因变量是艰难梭菌的培养结果，使用选择性培养基和商业厌氧菌鉴定试剂盒进行分离和鉴定。采用组织培养试验检测每株艰难梭菌产生毒素的能力。自变量（包括性别、年龄、种族、当前医学诊断、基础疾病严重程度、病例组合、当前临床症状、当前用药、标本采集前4周内使用抗生素情况以及其他相关病史）从每位参与者的当前病历中获取。
在获得的225份粪便培养物中，16份（7.1%）艰难梭菌检测呈阳性。培养阳性的居民均无症状。通过单因素分析，医院感染史以及一般抗生素、头孢菌素、甲氧苄啶/磺胺甲恶唑（TMP/SMX）和组胺-2受体阻滞剂的使用与艰难梭菌培养阳性显著相关（P≤0.05）。在麻醉药使用、既往住院、LTCF和非胰岛素依赖型糖尿病方面观察到有显著趋势（0.05＜P＜0.10）。逻辑回归分析显示培养阳性的显著独立预测因素：一般抗生素使用（P = 0.028；相对风险 = 3.31）、组胺-2拮抗剂使用（P = 0.038；相对风险 = 3.27）、头孢菌素使用（P = 0.038；相对风险 = 4.66）和TMP/SMX使用（P = 0.007；相对风险 = 8.45）。
抗生素的使用，尤其是头孢菌素和TMP/SMX，是长期护理机构中艰难梭菌无症状携带的重要危险因素。组胺-2受体阻滞剂的使用也是携带的重要危险因素；然而，这一发现此前尚未见报道，应通过独立研究予以证实。这些药物在LTCF人群中应谨慎使用。当LTCF居民出现腹泻病时，应高度怀疑艰难梭菌感染并采取适当的诊断和治疗措施。
