Epidemiology of Clostridium species bacteremia in Calgary, Canada, 2000-2006
Epidemiology of Clostridium species bacteremia in Calgary, Canada, 2000-2006
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DOI：
10.1016/j.jinf.2008.06.018
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发表时间：
2008-09-01
影响因子：
28.2
通讯作者：
Laupland, K. B.
中科院分区：
文献类型：
--
作者：
Leal, J.;Gregson, D. B.;Laupland, K. B.
目的：确定加拿大一个大型卫生区中与梭菌菌血症相关的发病率、感染风险因素和结果。方法：2000-2006 年期间，对卡尔加里卫生区的所有居民（人口 120 万）进行了基于人群的梭菌菌血症回顾性监测。结果：138 名居民发生了梭菌菌血症（每人 1.8 例）。 100,000/年）； 45 例 (33%) 为院内感染，55 例 (40%) 为医疗保健相关社区发病，38 例 (28%) 为社区获得性发病。年龄较大和一些潜在疾病是获得梭状芽胞杆菌菌血症的危险因素，最重要的是血液透析[相对风险（RR）212.3； 95% 置信区间 (CI) 106.5-385.5]、恶性肿瘤（RR 40.2；95% CI 27.6-58.1）和克罗恩病（RR 11.2；95% CI 3.0-29.4）。产气荚膜梭菌最常见，有 58 种（42%）分离株，其次是败血梭菌（19 种；14%）、小枝梭菌（13 种；9%）、梭状芽孢杆菌（8 种；6%）和艰难梭菌（7 种；5%）。 14/135 (10%) 菌株对青霉素敏感性降低，2/135 (1%) 菌株对甲硝唑敏感性降低，36/135 (27%) 菌株对克林霉素敏感性降低。中位住院时间为 12.7 天，39/130 (30%) 患者在医院死亡，死亡率为每 100,000 人/年 0.5 例。 结论：梭状芽胞杆菌菌血症与严重的疾病负担相关，血液透析和癌症患者的风险最高。 (c) 2008 年英国感染学会。由爱思唯尔有限公司出版。保留所有权利。
Objectives: To define the incidence, risk factors for acquisition, and outcomes associated with clostridial bacteremia in a large Canadian health region.Methods: Retrospective population-based surveillance for clostridial bacteremia was conducted among all residents of the Calgary Health Region (population 1.2 million) during 2000-2006.Results: One hundred and thirty-eight residents had incident Clostridium species bacteremia (1.8 per 100,000/year); 45 (33%) were nosocomial, 55 (40%) were healthcare-associated community onset, and 38 (28%) were community acquired. Older age and a number of underlying conditions were risk factors for acquiring Clostridium species bacteremia most importantly hemodialysis [relative risk (RR) 212.3; 95% confidence interval (CI) 106.5-385.5], malignancy (RR 40.2; 95% CI 27.6-58.1), and Crohn's disease (RR 11.2; 95% CI 3.0-29.4). Clostridium perfringens was most commonly identified with 58 (42%) isolates followed by Clostridium septicum (19; 14%), Clostridium ramosum (13; 9%), Clostridium clostridiiforme (8; 6%), and Clostridium difficile (7; 5%). Reduced susceptibility to penicillin occurred in 14/135 (10%), to metronidazole in 2/135 (1%), and to clindamycin in 36/135 (27%) isolates. The median length of stay was 12.7 days and 39/130 (30%) patients died in hospital for mortality rate of 0.5 per 100,000/year.Conclusions: Clostridium species bacteremia is associated with a significant burden of illness and hemodialysis and cancer patients are at highest risk. (c) 2008 The British Infection Society. Published by Elsevier Ltd. All rights reserved.