A point-prevalence study on community and inpatient Clostridioides difficile infections (CDI): results from Combatting Bacterial Resistance in Europe CDI (COMBACTE-CDI), July to November 2018.
A point-prevalence study on community and inpatient Clostridioides difficile infections (CDI): results from Combatting Bacterial Resistance in Europe CDI (COMBACTE-CDI), July to November 2018.
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DOI：
10.2807/1560-7917.es.2022.27.26.2100704
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发表时间：
2022-06
期刊：
影响因子：
19
通讯作者：
Davies, Kerrie A.
中科院分区：
文献类型：
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作者：
Viprey, Virginie F.;Davis, Georgina L.;Benson, Anthony D.;Ewin, Duncan;Spittal, William;Vernon, Jon J.;Rupnik, Maja;Banz, Alice;Allantaz, Florence;Cleuziat, Philippe;Wilcox, Mark H.;Davies, Kerrie A.
关于社区艰难梭菌感染（CDI）以及如何与住院患者CDI进行比较的数据很少。比较12个欧洲国家医院与社区中CDI人群的数据。对于这项点流行率研究（2018年7月至11月），检测中心在采样日将残留诊断材料发送至协调实验室进行CDI检测和PCR核糖分型（n = 3，163）。关于是否在原始研究中心要求进行CDI检测的信息用于识别未诊断的CDI。我们使用医疗记录来确定医疗机构在患者人口统计学和检测C的风险因素方面的差异。有或没有游离毒素的艰难梭菌。医院样本中CDI阳性率为4.4%（国家范围：0-16.2），社区样本中为1.3%（国家范围：0-2.2%）。毒素型IIIb（027、181和176）的最高流行率见于东欧国家（56%; 43/77），该地区的检测率最低（58%; 164/281）。观察到不同的易感风险因素（社区使用广谱青霉素（OR：8.09（1.9-35.6），p = 0.01）;医院使用氟喹诺酮类/头孢菌素（OR：2.2（1.2-4.3），p = 0.01; OR：2.0（1.1-3.7），p = 0.02））。由于缺乏临床怀疑，社区CDI病例中有一半未被发现，与医院相比，社区未被诊断的成年人多三倍（约111，000例/年，欧洲为37，000例/年）。这些研究结果支持改善社区腹泻患者诊断的建议，以指导限制CDI传播的良好实践。
There is a paucity of data on community-based Clostridioides difficile infection (CDI) and how these compare with inpatient CDI. To compare data on the populations with CDI in hospitals vs the community across 12 European countries. For this point-prevalence study (July–November 2018), testing sites sent residual diagnostic material on sampling days to a coordinating laboratory for CDI testing and PCR ribotyping (n = 3,163). Information on whether CDI testing was requested at the original site was used to identify undiagnosed CDI. We used medical records to identify differences between healthcare settings in patient demographics and risk factors for detection of C. difficile with or without free toxin. The CDI positivity rate was 4.4% (country range: 0–16.2) in hospital samples, and 1.3% (country range: 0–2.2%) in community samples. The highest prevalence of toxinotype IIIb (027, 181 and 176) was seen in eastern European countries (56%; 43/77), the region with the lowest testing rate (58%; 164/281). Different predisposing risk factors were observed (use of broad-spectrum penicillins in the community (OR: 8.09 (1.9–35.6), p = 0.01); fluoroquinolones/cephalosporins in hospitals (OR: 2.2 (1.2–4.3), p = 0.01; OR: 2.0 (1.1–3.7), p = 0.02)). Half of community CDI cases were undetected because of absence of clinical suspicion, accounting for three times more undiagnosed adults in the community compared with hospitals (ca 111,000 vs 37,000 cases/year in Europe). These findings support recommendations for improving diagnosis in patients presenting with diarrhoea in the community, to guide good practice to limit the spread of CDI.