CLOSTRIDIUM-DIFFICILE COLONIZATION AND DIARRHEA AT A TERTIARY CARE HOSPITAL
CLOSTRIDIUM-DIFFICILE COLONIZATION AND DIARRHEA AT A TERTIARY CARE HOSPITAL
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DOI：
10.1093/clinids/18.2.181
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发表时间：
1994-02-01
影响因子：
11.8
通讯作者：
KARCHMER, AW
中科院分区：
文献类型：
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作者：
SAMORE, MH;DEGIROLAMI, PC;KARCHMER, AW
艰难梭菌是院内腹泻的主要可识别感染原因。新英格兰女执事医院（波士顿）进行了一项前瞻性研究，以检查入院和随访时艰难梭菌携带的危险因素。每周对两个病房（一间内科，一间外科）和三个重症监护病房（两间外科，一间内科）收治的患者标本进行培养，直至出院。 496 名入院患者中，有 89 名 (18%) 至少有一种培养结果呈阳性。入院 72 小时内培养阳性率为 11%。入院时培养呈阳性的危险因素包括既往艰难梭菌腹泻（调整后比值比 [OR] = 9.5）、肾功能不全（OR = 6.7）和近期在其他地方住院（OR = 3.1）。最初培养结果为阴性并进行后续培养的患者中有 15% 获得了艰难梭菌。接受血管外科服务（相对风险 [RR] = 2.3）和肝移植（RR = 4.2）是艰难梭菌感染的重要危险因素。入院时无症状定植的患者随后发生艰难梭菌腹泻的风险非常低（每 44 人中有 1 人）。相比之下，19 名感染产毒菌株的患者中有 9 名 (47%) 出现艰难梭菌腹泻，这一发现表明，感染后早期就会进展为腹泻，或者根本不会发生。入院时培养阳性率相对较高可能是三级医院的特点，增加了控制这种院内病原体的难度。
Clostridium difficile is the major identifiable infectious cause of nosocomial diarrhea. A prospective study was conducted at New England Deaconess Hospital (Boston) to examine risk factors for C. difficile carriage at both admission and follow-up. Specimens from patients admitted to two wards (one medical, one surgical) and three intensive care units (two surgical, one medical) were cultured weekly until discharge. For 89 (18%) of 496 patient admissions, at least one culture was positive. The prevalence of culture positivity within 72 hours of admission was 11%. Risk factors for culture positivity at admission were prior C. difficile diarrhea (adjusted odds ratio [OR] = 9.5), renal insufficiency (OR = 6.7), and recent hospitalization elsewhere (OR = 3.1). Fifteen percent of patients for whom initial cultures were negative and for whom followup cultures were performed acquired C. difficile. Admission to the vascular surgery service (relative risk [RR] = 2.3) and liver transplantation (RR = 4.2) were significant risk factors for C. difficile acquisition. Patients asymptomatically colonized on admission had very low risk (1 in 44) for subsequent development of C. difficile diarrhea. In contrast, nine (47%) of 19 patients who acquired toxigenic strains developed C. difficile diarrhea, a finding suggesting that progression to diarrhea occurs early after acquisition or does not occur at all. The relatively high prevalence of culture positivity at admission may be characteristic of tertiary care hospitals and adds to the difficulty of controlling this nosocomial pathogen.