Recommendations for surveillance of Clostridium difficile-associated disease
Recommendations for surveillance of Clostridium difficile-associated disease
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DOI：
10.1086/511798
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发表时间：
2007-02-01
影响因子：
4.5
通讯作者：
Kutty, Preeta K.
中科院分区：
文献类型：
--
作者：
McDonald, L. Clifford;Coignard, Bruno;Kutty, Preeta K.
背景艰难梭菌相关疾病（CDAD）的流行病学正在发生变化，有证据表明其发病率和严重程度都在增加.然而，目前由于缺乏标准化的监测方法，对这种变化的程度和原因的理解受到阻碍。一个特别的C。艰难梭菌监测工作组的成立是为了在现有文献和专家意见的基础上制定临时监测定义和建议，以帮助改善CDAD的监测和预防工作。CDAD病例患者定义为腹泻或毒性巨结肠症状伴实验室检测阳性结果和/或假膜性结肠炎内镜或组织病理学证据的患者。复发性CDAD定义为8周内重复发作。重度CDAD的定义为CDAD相关的重症监护室入院、结肠切除术或发病后30天内死亡。病例患者根据C.由于最近的证据表明医疗机构相关的CDAD可能在出院后4周内在社区发病，因此可能获得了艰难梭菌。跟踪医疗保健机构发病、医疗保健机构相关的CDAD是医疗保健机构所需的最低监测;跟踪社区发病、医疗保健机构相关的CDAD应仅与跟踪医疗保健机构发病、医疗保健机构相关的CDAD结合进行。社区相关CDAD定义为最后一次从医疗机构出院后超过12周出现症状。医疗机构发病、医疗机构相关CDAD和社区发病、医疗机构相关CDAD的发生率均应表示为每10，000患者-天的病例患者;社区相关CDAD的发生率应表示为每100，000人-年的病例患者。
Background. The epidemiology of Clostridium difficile -associated disease (CDAD) is changing, with evidence of increased incidence and severity. However, the understanding of the magnitude of and reasons for this change is currently hampered by the lack of standardized surveillance methods.Objective and methods. An ad hoc C. difficile surveillance working group was formed to develop interim surveillance definitions and recommendations based on existing literature and expert opinion that can help to improve CDAD surveillance and prevention efforts.Definitions and recommendations. A CDAD case patient was defined as a patient with symptoms of diarrhea or toxic megacolon combined with a positive result of a laboratory assay and/or endoscopic or histopathologic evidence of pseudomembranous colitis. Recurrent CDAD was defined as repeated episodes within 8 weeks of each other. Severe CDAD was defined by CDAD-associated admission to an intensive care unit, colectomy, or death within 30 days after onset. Case patients were categorized by the setting in which C. difficile was likely acquired, to account for recent evidence that suggests that healthcare facility -associated CDAD may have its onset in the community up to 4 weeks after discharge. Tracking of healthcare facility -onset, healthcare facility -associated CDAD is the minimum surveillance required for healthcare settings; tracking of community-onset, healthcare facility -associated CDAD should be performed only in conjunction with tracking of healthcare facility -onset, healthcare facility -associated CDAD. Community-associated CDAD was defined by symptom onset more than 12 weeks after the last discharge from a healthcare facility. Rates of both healthcare facility -onset, healthcare facility associated CDAD and community-onset, healthcare facility -associated CDAD should be expressed as case patients per 10,000 patient-days; rates of community-associated CDAD should be expressed as case patients per 100,000 person-years.