NOSOCOMIAL ACQUISITION OF CLOSTRIDIUM-DIFFICILE INFECTION
NOSOCOMIAL ACQUISITION OF CLOSTRIDIUM-DIFFICILE INFECTION
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DOI：
10.1056/nejm198901263200402
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发表时间：
1989-01-26
影响因子：
158.5
通讯作者：
STAMM, WE
中科院分区：
文献类型：
--
作者：
MCFARLAND, LV;MULLIGAN, ME;STAMM, WE
我们通过对 11 个月内收治的 428 名患者的直肠拭子标本进行连续培养，前瞻性研究了普通内科病房中艰难梭菌感染的获得和传播情况。免疫印迹分型用于区分艰难梭菌的各个菌株。 7% 的患者 (29) 入院时培养结果呈阳性。 399 名培养结果呈阴性的患者中，有 83 名（21%）在住院期间感染了艰难梭菌。在这些患者中，52 人（63%）仍无症状，31 人（37%）有腹泻；没有人患有结肠炎。具有相同免疫印迹类型的事件病例的时空聚集以及暴露于培养物呈阳性的室友的患者中明显更频繁和更早地获得艰难梭菌，证明了艰难梭菌在患者之间的传播。在护理培养结果呈阳性的患者的医院工作人员中，59%（20 人）的手上检测到艰难梭菌培养结果呈阳性。有症状患者（49%）和无症状患者（29%）所在的病房经常受到污染。百分之八十二的感染者在出院时仍具有阳性培养物，此类患者出院到长期护理机构的可能性明显更大。我们得出的结论是，院内艰难梭菌感染（大约三分之一的病例与腹泻有关）经常在住院患者中传播，并且该微生物经常存在于照顾此类患者的医院工作人员的手上。需要采取有效的预防措施来减少艰难梭菌的医院感染。
We studied the acquisition and transmission of Clostridium difficile infection prospectively on a general medical ward by serially culturing rectal-swab specimens from 428 patients admitted over an 11-month period. Immunoblot typing was used to differentiate individual strains of C. difficile. Seven percent of the patients (29) had positive cultures at admission. Eighty-three (21 percent) of the 399 patients with negative cultures acquired C. difficile during their hospitalizations. Of these patients, 52 (63 percent) remained asymptomatic and 31 (37 percent) had diarrhea; none had colitis. Patient-to-patient transmission of C. difficile was evidenced by time-space clustering of incident cases with identical immunoblot types and by significantly more frequent and earlier acquisition of C. difficile among patients exposed to roommates with positive cultures. Of the hospital personnel caring for patients with positive cultures, 59 percent (20) had positive cultures for C. difficile from their hands. The hospital rooms occupied by symptomatic patients (49 percent) as well as those occupied by asymptomatic patients (29 percent) were frequently contaminated. Eighty-two percent of the infected cohort still had positive cultures at hospital discharge, and such patients were significantly more likely to be discharged to a long-term care facility. We conclude that nosocomial C. difficile infection, which was associated with diarrhea in about one third of cases, is frequently transmitted among hospitalized patients and that the organism is often present on the hands of hospital personnel caring for such patients. Effective preventive measures are needed to reduce nosocomial acquisition of C. difficile.