A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality
A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality
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DOI：
10.1056/nejmoa051639
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发表时间：
2005-12-08
影响因子：
158.5
通讯作者：
Dascal, A
中科院分区：
文献类型：
--
作者：
Loo, VG;Poirier, L;Dascal, A
背景：2003年3月，加拿大魁北克省的几家医院注意到艰难梭菌相关性腹泻的发病率明显增加。方法：2004年，我们在魁北克省的12家医院进行了一项前瞻性研究，以确定院内难抉择梭菌相关性腹泻及其并发症的发生率，并进行了一项病例对照研究，以确定该疾病的危险因素。采用脉冲场凝胶电泳技术对难辨梭菌分离株进行分型，并分析其毒素A和B抑制基因tcdC的二元毒素基因和部分缺失。在一个亚群中评估了菌株的抗菌药物敏感性。结果：共发现1703例院内难辨梭菌相关性腹泻患者1719例。发病率为22.5 / 1000。30天可归因死亡率为6.9%。病例患者比对照组更有可能接受氟喹诺酮类药物（优势比，3.9；95%可信区间，2.3至6.6）或头孢菌素（优势比，3.8；95%可信区间，2.2至6.6）。157株分离株中有129株（82.2%）存在对氟喹诺酮类药物耐药的优势菌株，132株（84.1%）存在二元毒素基因和tcdC基因部分缺失。结论：一株难辨梭菌对氟喹诺酮类药物耐药，具有二元毒素，tcdC基因部分缺失，是此次难辨梭菌相关性腹泻暴发的原因。接触氟喹诺酮类药物或头孢菌素是一个危险因素。
BACKGROUND:In March 2003, several hospitals in Quebec, Canada, noted a marked increase in the incidence of Clostridium difficile-associated diarrhea.METHODS:In 2004 we conducted a prospective study at 12 Quebec hospitals to determine the incidence of nosocomial C. difficile-associated diarrhea and its complications and a case-control study to identify risk factors for the disease. Isolates of C. difficile were typed by pulsed-field gel electrophoresis and analyzed for binary toxin genes and partial deletions in the toxin A and B repressor gene tcdC. Antimicrobial susceptibility was evaluated in a subgroup of isolates.RESULTS:A total of 1703 patients with 1719 episodes of nosocomial C. difficile-associated diarrhea were identified. The incidence was 22.5 per 1000 admissions. The 30-day attributable mortality rate was 6.9 percent. Case patients were more likely than matched controls to have received fluoroquinolones (odds ratio, 3.9; 95 percent confidence interval, 2.3 to 6.6) or cephalosporins (odds ratio, 3.8; 95 percent confidence interval, 2.2 to 6.6). A predominant strain, resistant to fluoroquinolones, was found in 129 of 157 isolates (82.2 percent), and the binary toxin genes and partial deletions in the tcdC gene were present in 132 isolates (84.1 percent).CONCLUSIONS:A strain of C. difficile that was resistant to fluoroquinolones and had binary toxin and a partial deletion of the tcdC gene was responsible for this outbreak of C. difficile-associated diarrhea. Exposure to fluoroquinolones or cephalosporins was a risk factor.