NAP1 Strain Type Predicts Outcomes From Clostridium difficile Infection
NAP1 Strain Type Predicts Outcomes From Clostridium difficile Infection
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DOI：
10.1093/cid/ciu125
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发表时间：
2014-05-15
影响因子：
11.8
通讯作者：
Lessa, Fernanda C.
中科院分区：
文献类型：
--
作者：
See, Isaac;Mu, Yi;Lessa, Fernanda C.
背景关于氟喹诺酮耐药的北美脉冲场凝胶电泳1型（NAP 1）菌株在艰难梭菌感染（CDI）结局中的重要性，研究相互矛盾。我们描述了导致CDI的菌株类型，并评估其与患者结局的相关性。从基于人群的监测中确定了CDI病例。采用多变量回归模型评估菌株类型与严重疾病（5天内肠梗阻、中毒性巨结肠或伪膜性结肠炎;或阳性检测1天内白色血细胞计数>= 15 000个细胞/μ L）、严重结局（阳性检测后入住重症监护室、因C.艰难梭菌感染或阳性检测30天内死亡）和阳性检测14天内死亡。2057例病例的菌株分型结果可用。363例（17.7%）发生严重疾病，100例（4.9%）发生严重结局，56例（2.7%）在14天内死亡。最常见的菌株类型为NAP 1（28.4%）、NAP 4（10.2%）和NAP 11（9.1%）。在未校正的分析中，NAP 1与严重疾病的几率比其他菌株更大。在控制了患者风险因素、医疗暴露和抗生素使用后，NAP 1与严重疾病相关。（校正比值比[AOR]，1.74; 95%置信区间[CI]，1.36-2.22），重度结局（AOR，1.66; 95%CI，1.09-2.54），14天内死亡（AOR，2.12; 95%CI，1.22-3.68）。NAP 1是最流行的菌株，也是严重疾病、严重结局和死亡的预测因子。降低NAP 1患病率的策略，如抗生素管理以减少氟喹诺酮类药物的使用，可能会降低CDI的发病率。
Background. Studies are conflicting regarding the importance of the fluoroquinolone-resistant North American pulsed-field gel electrophoresis type 1 (NAP1) strain in Clostridium difficile infection (CDI) outcome. We describe strain types causing CDI and evaluate their association with patient outcomes.Methods. CDI cases were identified from population-based surveillance. Multivariate regression models were used to evaluate the associations of strain type with severe disease (ileus, toxic megacolon, or pseudomembranous colitis within 5 days; or white blood cell count >= 15 000 cells/mu L within 1 day of positive test), severe outcome (intensive care unit admission after positive test, colectomy for C. difficile infection, or death within 30 days of positive test), and death within 14 days of positive test.Results. Strain typing results were available for 2057 cases. Severe disease occurred in 363 (17.7%) cases, severe outcome in 100 (4.9%), and death within 14 days in 56 (2.7%). The most common strain types were NAP1 (28.4%), NAP4 (10.2%), and NAP11 (9.1%). In unadjusted analysis, NAP1 was associated with greater odds of severe disease than other strains. After controlling for patient risk factors, healthcare exposure, and antibiotic use, NAP1 was associated with severe disease (adjusted odds ratio [AOR], 1.74; 95% confidence interval [CI], 1.36-2.22), severe outcome (AOR, 1.66; 95% CI, 1.09-2.54), and death within 14 days (AOR, 2.12; 95% CI, 1.22-3.68).Conclusions. NAP1 was the most prevalent strain and a predictor of severe disease, severe outcome, and death. Strategies to reduce NAP1 prevalence, such as antibiotic stewardship to reduce fluoroquinolone use, might reduce CDI morbidity.