Comparative analysis of prevalence, risk factors, and molecular epidemiology of antibiotic-associated diarrhea due to Clostridium difficile, Clostridium perfringens, and Staphylococcus aureus
Comparative analysis of prevalence, risk factors, and molecular epidemiology of antibiotic-associated diarrhea due to Clostridium difficile, Clostridium perfringens, and Staphylococcus aureus
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DOI：
10.1128/jcm.00165-06
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发表时间：
2006-08-01
影响因子：
9.4
通讯作者：
Wilcox, M. H.
中科院分区：
文献类型：
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作者：
Asha, N. J.;Tompkins, D.;Wilcox, M. H.
我们前瞻性地研究了艰难梭菌、产气荚膜梭菌和金黄色葡萄球菌抗生素相关性腹泻 (AAD) 的比较流行病学和危险因素。分别通过 Vero 细胞测定、酶联免疫吸附测定和新鲜血琼脂生长法对 4659 份住院患者粪便标本（11 个月）进行了艰难梭菌细胞毒素、产气荚膜梭菌肠毒素和金黄色葡萄球菌检测。两个不同的年龄、性别和地点匹配的对照患者组用于多变量逻辑回归危险因素分析：AAD 病原体阴性的有症状患者和有近期抗菌治疗史的无症状患者。所有 AAD 病原体分离株均进行了 DNA 指纹分析。在 AAD 病例中，艰难梭菌细胞毒素、产气荚膜梭菌肠毒素和金黄色葡萄球菌的患病率分别为 12.7%、3.3% 和 0.2%（总体为 15.8%）。年龄 >70 岁是常见的危险因素。感染性 AAD 和艰难梭菌 AAD 的其他危险因素包括住院时间和饲管的使用（住院时间比值比 [OR]，1.017 和 1.012；饲管 OR，1.864 和 2.808）。女性性别和抗酸剂的使用与产气荚膜梭菌 AAD 风险增加显着相关（OR 分别为 2.08 和 2.789），但与艰难梭菌 AAD 的发现不同，特定抗生素类别与风险增加无关。大多数艰难梭菌和产气荚膜梭菌 AAD 病例是由有限数量的基因型引起的。与艰难梭菌 AAD 的发现类似，流行病学证据表明产气荚膜梭菌 AAD 病例因不同菌株而聚集和再感染。艰难梭菌 AAD 的常见程度分别是产气荚膜梭菌 AAD 和金黄色葡萄球菌 AAD 的约 4 倍和 60 倍。这些 AAD 病原体的 Fisk 因素各不相同，突出表明需要制定具体的控制措施。有证据表明产气荚膜梭菌 AAD 病例存在院内传播。
We prospectively studied the comparative epidemiology and risk factors for Clostridium difficile, Clostridium perfringens, and Staphylococcus aureus antibiotic-associated diarrhea (AAD). Four thousand six hundred fifty-nine inpatient fecal specimens (11 months) were tested for C difficile cytotoxin, C perfringens enterotoxin, and S. aureus by Vero cell assay, enzyme-linked immunosorbent assay, and growth on fresh blood agar, respectively. Two distinct age-, sex-, and location-matched control patient groups were used for multivariate logistic regression risk factor analyses: symptomatic patients who were AAD pathogen negative and asymptomatic patients with histories of recent antimicrobial therapy. All AAD pathogen isolates were DNA fingerprinted. In AAD cases, the prevalences of C difficile cytotoxin, C perfringens enterotoxin, and S. aureus were 12.7%, 3.3%, and 0.2%, respectively (15.8% overall). Age of >70 years was a common risk factor. Other risk factors for infective AAD and C difficile AAD included length of hospital stay and use of feeding tubes (length of stay odds ratios [OR], 1.017 and 1.012; feeding tube OR, 1.864 and 2.808). Female gender and use of antacids were significantly associated with increased risk of C perfringens AAD (OR, 2.08 and 2.789, respectively), but unlike what was found for C difficile AAD, specific antibiotic classes were not associated with increased risk. A limited number of genotypes caused the majority of C difficile and C perfringens AAD cases. Similar to what was found for C. difficile AAD, there was epidemiological evidence of C. perfringens AAD case clustering and reinfection due to different strains. C difficile AAD was approximately 4 and 60 times more common than C. perfringens AAD and S. aureus AAD, respectively. Fisk factors for these AAD pathogens differed, highlighting the need to define specific control measures. There is evidence of nosocomial transmission in cases of C. perfringens AAD.