Mainardi J L, Lacassin F, Guilloy Y, Goldstein F W, Leport C, Acar J F, Vildé J L
Laboratoire de Microbiologie Clinique, Fondation Hôpital Saint-Joseph, Paris, France.
J Infect. 1998 Sep;37(2):108-11. doi: 10.1016/s0163-4453(98)80162-x.
To determine the frequency of Clostridium difficile carriage in HIV-infected in- and out-patients, and to assess the role of this carriage in nosocomial transmission of C. difficile.
Prospective study in a university hospital. Forty-five consecutive HIV-infected out-patients and 120 hospitalized patients (52 HIV and 68 non HIV-infected-patients) were studied. During the period of hospitalization, 44 patients (24 HIV and 20 non-HIV-infected patients) with a negative culture within 48 h of admission were followed weekly for fecal carriage. Clostridium difficile culture and latex agglutination were performed on the fecal samples of each patient. In the case of positive culture and/or latex agglutination, C. difficile toxin assays were performed by microtitre cytotoxicity method.
Out-patients: one patient was a carrier and one patient with diarrhoea was infected with a toxigenic strain (2/45, 4.5%, 95% CI = 1-17). Eighty percent of the HIV-infected out-patients had received antimicrobial agents previously. In-patients: in the first 48 h, five asymptomatic patients were carriers (three non-HIV and two HIV-infected patients). Among 20 patients who complained of diarrhoea, one HIV-infected patient had only a positive latex agglutination and one HIV-infected patient was infected with a toxigenic strain. Overall, 7/120 (5.8%, 95% CI = 2-10) patients were infected or colonized with C. difficile. During the hospitalization (743 patient-days), none of the 44 patients acquired C. difficile.
This study suggests that in this given unit, C. difficile carriage is low, at least with single room accommodation, and in the absence of clusters of cases. This carriage is not different in HIV and non-HIV infected patients despite treatment with multiple antibiotics, and is not different in patients managed in different care environments. The systematic identification of C. difficile carriers for isolation and prophylactic treatment is not useful under these circumstances.
确定HIV感染的门诊和住院患者中艰难梭菌携带情况的频率，并评估这种携带情况在艰难梭菌医院内传播中的作用。
在一家大学医院进行的前瞻性研究。对45例连续的HIV感染门诊患者和120例住院患者（52例HIV感染患者和68例非HIV感染患者）进行了研究。在住院期间，对44例入院后48小时内培养结果为阴性的患者（24例HIV感染患者和20例非HIV感染患者）每周进行粪便携带情况随访。对每位患者的粪便样本进行艰难梭菌培养和乳胶凝集试验。若培养结果和/或乳胶凝集试验呈阳性，则通过微量滴定细胞毒性法进行艰难梭菌毒素检测。
门诊患者：1例为携带者，1例腹泻患者感染了产毒菌株（2/45，4.5%，95%可信区间=1-17）。80%的HIV感染门诊患者之前接受过抗菌药物治疗。住院患者：在最初的48小时内，5例无症状患者为携带者（3例非HIV感染患者和2例HIV感染患者）。在20例主诉腹泻的患者中，1例HIV感染患者仅乳胶凝集试验呈阳性，1例HIV感染患者感染了产毒菌株。总体而言，7/120（5.8%，95%可信区间=2-10）例患者感染或定植了艰难梭菌。在住院期间（743个患者日），44例患者中无一例获得艰难梭菌感染。
本研究表明，在该特定科室，艰难梭菌携带率较低，至少在单人病房且无病例聚集的情况下如此。尽管使用了多种抗生素，但HIV感染患者和非HIV感染患者的这种携带情况并无差异，且在不同护理环境下管理的患者中也无差异。在这些情况下，对艰难梭菌携带者进行系统识别以进行隔离和预防性治疗并无用处。
