Host and Pathogen Factors for Clostridium difficile Infection and Colonization
Host and Pathogen Factors for Clostridium difficile Infection and Colonization
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DOI：
10.1056/nejmoa1012413
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发表时间：
2011-11-03
影响因子：
158.5
通讯作者：
Dascal, Andre
中科院分区：
文献类型：
--
作者：
Loo, Vivian G.;Bourgault, Anne-Marie;Dascal, Andre
研究背景艰难梭菌感染是引起卫生保健相关性腹泻的主要原因，也可无症状携带。本研究的目的是确定与卫生保健相关的C。我们在魁北克和安大略的6家加拿大医院进行了为期15个月的前瞻性研究。收集人口统计学信息、已知风险因素、潜在混杂因素和每周粪便样本或直肠拭子。采用脉冲场凝胶电泳（PFGE）技术对C.艰难分离株，以确定基因型。血清抗C.艰难梭菌毒素A和B进行了测量。ResultsA共4143例患者被纳入研究; 117例（2.8%）和123例（3.0%）有卫生保健相关的C。difficile感染和定植。年龄较大、抗生素和质子泵抑制剂的使用与医疗保健相关的C。艰难感染前2个月内住院、使用化疗、质子泵抑制剂和H-2阻滞剂以及抗毒素B抗体与医疗保健相关C相关。艰难的殖民在与医疗保健相关的C。艰难梭菌感染和定植者中，分别有62.7%和36.1%，有北美PFGE 1型（NAP 1）菌株。艰难梭菌感染和定殖与确定的宿主和病原体变量不同地相关。NAP 1株在C.艰难梭菌感染，而无症状的患者更有可能与其他菌株定殖。（由Consortium de Recherche sur le Clostridium difficile资助。
BackgroundClostridium difficile infection is the leading cause of health care-associated diarrhea, and the bacterium can also be carried asymptomatically. The objective of this study was to identify host and bacterial factors associated with health care-associated acquisition of C. difficile infection and colonization.MethodsWe conducted a 15-month prospective study in six Canadian hospitals in Quebec and Ontario. Demographic information, known risk factors, potential confounding factors, and weekly stool samples or rectal swabs were collected. Pulsed-field gel electrophoresis (PFGE) was performed on C. difficile isolates to determine the genotype. Levels of serum antibodies against C. difficile toxins A and B were measured.ResultsA total of 4143 patients were included in the study; 117 (2.8%) and 123 (3.0%) had health care-associated C. difficile infection and colonization, respectively. Older age and use of antibiotics and proton-pump inhibitors were significantly associated with health care-associated C. difficile infection. Hospitalization in the previous 2 months; use of chemotherapy, proton-pump inhibitors, and H-2 blockers; and antibodies against toxin B were associated with health care-associated C. difficile colonization. Among patients with health care-associated C. difficile infection and those with colonization, 62.7% and 36.1%, respectively, had the North American PFGE type 1 (NAP1) strain.ConclusionsIn this study, health care-associated C. difficile infection and colonization were differentially associated with defined host and pathogen variables. The NAP1 strain was predominant among patients with C. difficile infection, whereas asymptomatic patients were more likely to be colonized with other strains. (Funded by the Consortium de Recherche sur le Clostridium difficile.)