Burden of Clostridium difficile Infection in the United States
Burden of Clostridium difficile Infection in the United States
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DOI：
10.1056/nejmoa1408913
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发表时间：
2015-02-26
影响因子：
158.5
通讯作者：
McDonald, L. Clifford
中科院分区：
文献类型：
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作者：
Lessa, Fernanda C.;Mu, Yi;McDonald, L. Clifford
在美国，艰难梭菌感染的程度和范围在不断发展。方法2011年，我们在美国10个地理区域开展了活跃的人群和实验室监测，以确定艰难梭菌感染病例（在1岁以上的居民中，粪便标本在毒素或分子检测中呈艰难梭菌阳性）。病例分为社区相关或卫生保健相关。在难辨梭菌感染病例样本中，培养标本并对分离株进行分子分型。我们使用回归模型计算艰难梭菌感染诊断后30天内全国发病率和感染总数、首次复发率和死亡人数的估计值。结果10个地区共检出难辨梭菌感染15461例；65.8%与医疗保健有关，但只有24.2%在住院期间发病。在调整疾病发病率预测因子后，美国难辨梭菌感染事件的估计数量为453,000例（95%可信区间[CI]， 397,100至508,500）。据估计，女性（比率比，1.26;95% CI， 1.25至1.27）、白人（比率比，1.72;95% CI， 1.56至2.0）和65岁及以上人群（比率比，8.65;95% CI， 8.16至9.31）的发病率较高。艰难梭菌感染首次复发的估计人数为83,000 (95% CI, 57,000至108,900)，估计死亡人数为29,300 （95% CI, 16,500至42,100）。北美脉冲场凝胶电泳1型（NAP1）菌株在卫生保健相关感染中的流行率高于社区相关感染（30.7%比18.8%，P< 0.001）。艰难梭菌导致了近50万例感染，并在2011年导致约2.9万人死亡。
BACKGROUNDThe magnitude and scope of Clostridium difficile infection in the United States continue to evolve.METHODSIn 2011, we performed active population-and laboratory-based surveillance across 10 geographic areas in the United States to identify cases of C. difficile infection (stool specimens positive for C. difficile on either toxin or molecular assay in residents >= 1 year of age). Cases were classified as community-associated or health care-associated. In a sample of cases of C. difficile infection, specimens were cultured and isolates underwent molecular typing. We used regression models to calculate estimates of national incidence and total number of infections, first recurrences, and deaths within 30 days after the diagnosis of C. difficile infection.RESULTSA total of 15,461 cases of C. difficile infection were identified in the 10 geographic areas; 65.8% were health care-associated, but only 24.2% had onset during hospitalization. After adjustment for predictors of disease incidence, the estimated number of incident C. difficile infections in the United States was 453,000 (95% confidence interval [CI], 397,100 to 508,500). The incidence was estimated to be higher among females (rate ratio, 1.26; 95% CI, 1.25 to 1.27), whites (rate ratio, 1.72; 95% CI, 1.56 to 2.0), and persons 65 years of age or older (rate ratio, 8.65; 95% CI, 8.16 to 9.31). The estimated number of first recurrences of C. difficile infection was 83,000 (95% CI, 57,000 to 108,900), and the estimated number of deaths was 29,300 (95% CI, 16,500 to 42,100). The North American pulsed-field gel electrophoresis type 1 (NAP1) strain was more prevalent among health care-associated infections than among community-associated infections (30.7% vs. 18.8%, P< 0.001)CONCLUSIONSC. difficile was responsible for almost half a million infections and was associated with approximately 29,000 deaths in 2011.