Relapse versus reinfection: recurrent Clostridium difficile infection following treatment with fidaxomicin or vancomycin.
Relapse versus reinfection: recurrent Clostridium difficile infection following treatment with fidaxomicin or vancomycin.
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DOI：
10.1093/cid/cis357
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发表时间：
2012-08
期刊：
影响因子：
--
通讯作者：
Gerding DN
中科院分区：
文献类型：
--
作者：
Figueroa I;Johnson S;Sambol SP;Goldstein EJ;Citron DM;Gerding DN
我们的研究旨在比较导致首次和复发性艰难梭菌感染 (CDI) 的艰难梭菌菌株类型，这些患者在过去 90 天内曾发生过首次 CDI 感染或先前发生过 1 次 CDI。菌株源自已进入非达霉素与万古霉素两项 3 期随机临床试验的患者。使用限制性核酸内切酶分析 (REA) 分型对 CDI 治愈 28 (±2) 天内首次和复发的艰难梭菌分离株进行比较。 194 名复发性 CDI 患者中的 90 名 (46%) 获得了配对分离株。与没有分离株的患者相比，具有可用分离株的患者明显更年轻 (P = .008)，并且更有可能来自加拿大站点 (P = .0001)。在 90 名受试者中的 75 名 (83.3%) 中，在复发和初次发作（假定复发）时鉴定出相同的 REA 型菌株。早期复发（治疗完成后 0-14 天）的复发率为 86.7%，新菌株（再感染）为 13.3%。后来的复发（治疗后 15-31 天）中复发率为 76.7%，再感染率为 23.3%。复发的平均时间（±标准差）为 12.2 (±6.4) 天，再感染的平均时间为 14.7 (±6.8) 天 (P = .177)。与其他 REA 组相比，最常见的 BI/NAP1/027 组和之前美国流行的 REA 组 J/NAP2/001 的合并复发率（复发）显着高于其他 REA 组（分别为 42 例中的 39 例 [93%] 和 48 例中的 36 例 [75%]；P = .023）。我们发现由与原始病例相同的分离株引起的 CDI 复发率高于历史水平，这一发现可能与本研究中观察期相对较短以及流行毒株分离频率较高有关，例如 BI 组和 J 组，其复发率可能高于其他 REA 组。在概括这些观察结果时需要谨慎，因为与未提供分离株的复发患者相比，所研究的患者更年轻，而且更有可能来自加拿大。临床试验注册。 NCT00314951 和 NCT00468728。
Our study sought to compare the strain types of Clostridium difficile causing initial and recurrent episodes of C. difficile infection (CDI) in adult patients with a first episode of CDI or 1 prior episode of CDI within the previous 90 days. Strains originated from patients who had been entered into two phase 3 randomized clinical trials of fidaxomicin versus vancomycin. Isolates of C. difficile from the initial and recurrent episodes within 28 (±2) days of cure of CDI were compared using restriction endonuclease analysis (REA) typing. Paired isolates were available from 90 of 194 (46%) patients with recurrent CDI. Patients with isolates available were significantly younger (P = .008) and more likely to be from Canadian sites (P = .0001), compared with patients without isolates. In 75 of 90 subjects (83.3%), the identical REA type strain was identified at recurrence and the initial episode (putative relapse). Early recurrences (0–14 days after treatment completion) were relapses in 86.7% and a new strain (reinfection) in 13.3%. Later recurrences (15–31 days after treatment) were relapses in 76.7% and reinfections in 23.3%. Mean time (± standard deviation) to recurrence was 12.2 (±6.4) days for relapses and 14.7 (±6.8) days for reinfections (P = .177). The most common BI/NAP1/027 group and the previous US epidemic REA group J/NAP2/001 had a significantly higher combined rate of recurrence with the same strain (relapse), compared with the other REA groups (39 of 42 [93%] vs 36 of 48 [75%], respectively; P = .023). We found a higher than historic rate of recurrent CDI caused by the same isolate as the original episode, a finding that may be related to the relatively short observation period in this study and the high frequency of isolation of epidemic strains, such as groups BI and J, for which relapse rates may be higher than for other REA groups. Caution in generalizing these observations is required, because the patients studied were younger and more likely to be from Canadian sites than were patients with recurrence who did not provide isolates. Clinical Trials Registration. NCT00314951 and NCT00468728.
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影响因子：
158.5
作者：
Louie, Thomas J.;Miller, Mark A.;Shue, Youe-Kong
通讯作者：
Shue, Youe-Kong
影响因子：
9.4
作者：
Killgore, George;Thompson, Angela;McDonald, L. Clifford
通讯作者：
McDonald, L. Clifford
影响因子：
9.4
作者：
Tang-Feldman, Y;Mayo, S;Cohen, SH
通讯作者：
Cohen, SH
影响因子：
6.9
作者：
Wilcox, MH;Fawley, WN;Davidson, A
通讯作者：
Davidson, A
影响因子：
4.2
作者：
ONEILL, GL;BEAMAN, MH;RILEY, TV
通讯作者：
RILEY, TV