A large outbreak of Clostridium Difficile -: Associated disease with an unexpected proportion of deaths and colectomies at a teaching hospital following increased fluoroquinolone use
A large outbreak of Clostridium Difficile -: Associated disease with an unexpected proportion of deaths and colectomies at a teaching hospital following increased fluoroquinolone use
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DOI：
10.1086/502539
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发表时间：
2005-03-01
影响因子：
4.5
通讯作者：
Saul, M
中科院分区：
文献类型：
--
作者：
Muto, CA;Pokrywka, M;Saul, M
背景与目的：氟喹诺酮类药物并没有经常被认为是艰难梭菌爆发的原因。院内难辨梭菌感染从2.7例/ 1000例增加到6.8例/ 1000例（P < 0.001）。在暴发的头两年，有253例院内难辨梭菌感染；其中26例结肠切除术，18例死亡。我们对我院的一次大规模艰难梭菌暴发进行了调查，以确定暴发的危险因素和特征。方法：对2000年1月至2001年4月期间的艰难梭菌感染病例和对照患者进行回顾性病例对照研究，对照患者根据入院日期、医疗服务类型和住院时间进行匹配；住院患者抗生素使用情况分析；对分离株进行药敏试验和分子分型。结果：经logistic回归分析，克林霉素（比值比[OR]， 4.8； 95%可信区间[CI95]， 1.9 ~ 12.0）、头孢曲松（比值比[OR]， 5.4; CI95, 1.8 ~ 15.8）、左氧氟沙星（比值比[OR]， 2.0; CI95, 1.2 ~ 3.3）与感染独立相关。3种病原菌的致病率分别为10.0%、6.7%和30.8%。氟喹诺酮类药物的使用在疫情发生前有所增加（P < 0.001）；59%的病例患者和41%的对照患者接受了这类抗生素。暴发是多克隆的，尽管52%的分离株属于两种高度相关的分子亚型。结论：暴露于左氧氟沙星是艰难梭菌相关性腹泻的独立危险因素，似乎是此次暴发的主要原因，可能需要限制左氧氟沙星和其他相关抗生素的使用来控制暴发。
BACKGROUND AND OBJECTIVE: Fluoroquinolones have not been frequently implicated as a cause of Clostridium difficile outbreaks. Nosocornial C. difficile infections increased from 2.7 to 6.8 cases per 1,000 discharges (P < .001). During the first 2 years of the outbreak, there were 253 nosocomial C difficile infections; of these, 26 resulted in colectomy and 18 resulted in death. We conducted an investigation of a large C. difficile outbreak in our hospital to identify risk factors and characterize the outbreak.METHODS: A retrospective case-control study of case-patients with C. difficile infection from January 2000 through April 2001 and control-patients matched by date of hospital admission, type of medical service, and length of stay; an analysis of inpatient antibiotic use; and antibiotic susceptibility testing and molecular subtyping of isolates were performed.RESULTS: On logistic regression analysis, clindamycin (odds ratio [OR], 4.8; 95% confidence interval [CI95], 1.9-12.0), ceftriaxone (OR, 5.4; CI95, 1.8-15.8), and levofloxacin (OR, 2.0; CI95, 1.2-3.3) were independently associated with infection. The etiologic fractions for these three agents were 10.0%, 6.7%, and 30.8%, respectively. Fluoroquinolone use increased before the onset of the outbreak (P < .001); 59% of case-patients and 41% of control-patients had received this antibiotic class. The outbreak was polyclonal, although 52% of isolates belonged to two highly related molecular subtypes.CONCLUSIONS: Exposure to levofloxacin was an independent risk factor for C. difficile-associated diarrhea and appeared to contribute substantially to the outbreak, Restricted use of levofloxacin and the other implicated antibiotics may be required to control the outbreak.