Primary symptomless colonisation by Clostridium difficile and decreased risk of subsequent diarrhoea
Primary symptomless colonisation by Clostridium difficile and decreased risk of subsequent diarrhoea
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DOI：
10.1016/s0140-6736(97)08062-8
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发表时间：
1998-02-28
期刊：
影响因子：
168.9
通讯作者：
Gerding, DN
中科院分区：
文献类型：
--
作者：
Shim, JK;Johnson, S;Gerding, DN
背景：对于发生艰难梭菌相关性腹泻（CDAD）的患者在患病前是培养阳性还是培养阴性知之甚少。最重要的风险因素是抗生素暴露。我们的目的是找出是否被确定为原发性无菌艰难梭菌载体的患者是在更高的风险发展CDAD比谁是culture-negative.Method的患者，我们回顾了四个纵向研究，其中810例患者入院随访前瞻性直肠拭子文化。至少连续两周获得培养物。我们计算了每项研究中定植和非定植患者之间CDAD风险的差异，并将四项研究的结果合并到随机效应模型中。（平均随访1.7周[SD 1.3]），22 CDAD发生率为3.6%，而在192名原发性无梅毒携带者中只有2名（1.0%）（1.5 [1.5]）发展为CDAD（合并风险差异-2.3% [95%CI 0.3-4.3]，p=0.021）。在接受抗生素治疗的患者中，风险差异增加：491例非定植患者中有22例（4.5%）与176例定植患者中的2例（1.1%）发生CDAD（-3.2% [0.4-6.0]，p=0.024）。在主要无致病性艰难梭菌携带者中，95例定植有致病性菌株，76例定植有非致病性菌株，12例定植有致病性和非致病性菌株（非同时），9例定植有未确定致病性菌株。12个导致CDAD的艰难梭菌分离株中的9个也从无菌患者的粪便中回收。虽然机制尚不清楚，但在非产芽孢杆菌和产芽孢杆菌菌株的定殖中发现风险降低。
Background Little is known about whether patients who develop Clostridium-difficile-associated diarrhoea (CDAD) are culture-positive or culture-negative before illness. The most important risk factor is antibiotic exposure. We aimed to find out whether patients identified as primary symptom-free C difficile carriers are at higher risk of developing CDAD than patients who are culture-negative.Method We reviewed four longitudinal studies in which 810 patients admitted to hospital were followed up by prospective rectal-swab culture. At least two consecutive weekly cultures were obtained. We calculated the difference in risk of CDAD between colonised and non-colonised patients in each study and combined the results of the four studies in a random-effects model.Findings Of 618 non-colonised patients (mean follow-up 1.7 weeks [SD 1.3]), 22 (3.6%) developed CDAD, whereas only two (1.0%) of 192 primary symptom-free carriers (1.5 [1.5]) developed CDAD (pooled risk difference -2.3% [95% CI 0.3-4.3], p=0.021). Of patients who received antibiotics, the risk difference was increased: 22 (4.5%) of 491 non-colonised patients compared with two (1.1%) of 176 colonised patients developed CDAD (-3.2% [0.4-6.0], p=0.024). Of the primary symptom-free C difficile carriers, 95 were colonised with toxigenic strains, 76 with nontoxigenic strains, 12 with both toxigenic and non-toxigenic strains (non-concurrently), and nine with strains of undetermined toxigenicity. Nine of the 12 toxogenic strains of C difficile isolates that cause CDAD were also recovered from stools of symptom-free patients.Interpretation Primary symptomless C difficile colonisation is associated with a decreased risk of CDAD. Although the mechanism is unknown, risk reduction is found in colonisation with non-toxigenic and toxigenic strains.