Health Care-Associated Clostridium difficile Infection in Adults Admitted to Acute Care Hospitals in Canada: A Canadian Nosocomial Infection Surveillance Program Study
Health Care-Associated Clostridium difficile Infection in Adults Admitted to Acute Care Hospitals in Canada: A Canadian Nosocomial Infection Surveillance Program Study
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DOI：
10.1086/596703
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发表时间：
2009-03-01
影响因子：
11.8
通讯作者：
Mulvey, Michael
中科院分区：
文献类型：
--
作者：
Gravel, Denise;Miller, Mark;Mulvey, Michael
背景。艰难梭菌感染（CDI）是最常见的原因卫生保健相关的传染性腹泻在工业化国家。加拿大医院感染监测计划于1997年对加拿大与卫生保健相关的CDI （HA CDI）发病率进行了唯一的报告。我们重新检查了HA CDI的发生率，重点关注患者的预后。从2004年11月1日至2005年4月30日进行了前瞻性监测。收集基本的人口统计数据，包括年龄、性别、确定HA CDI当天患者住院的病房类型和患者合并症。在诊断为HA CDI后30天收集严重结局数据；严重转归定义为因CDI并发症、因CDI结肠切除术和/或因CDI死亡而入住重症监护病房。在6个月的监测期间，29家医院共发现1430名成人HA CDI。在这些医院住院的成年患者中，HA CDI的总发病率为每1000名住院患者4.6例，每10万名患者日65例。在HA CDI发病后30天，233名患者（16.3%）死于各种原因；31例死亡（2.2%）是CDI直接导致的，51例死亡（3.6%）与CDI间接相关，总归因死亡率为5.7%。这些比率与我们之前的研究结果非常相似；尽管我们发现参与调查的医院在HA CDI方面存在很大差异。然而，可归因死亡率增加了近4倍（5.7% vs. 1.5%）。P
Background. Clostridium difficile infection (CDI) is the most frequent cause of health care-associated infectious diarrhea in industrialized countries. The only previous report describing the incidence of health care-associated CDI (HA CDI) in Canada was conducted in 1997 by the Canadian Nosocomial Infection Surveillance Program. We re-examined the incidence of HA CDI with an emphasis on patient outcomes.Methods. A prospective surveillance was conducted from 1 November 2004 through 30 April 2005. Basic demographic data were collected, including age, sex, type of patient ward where the patient was hospitalized on the day HA CDI was identified, and patient comorbidities. Data regarding severe outcome were collected 30 days after the diagnosis of HA CDI; severe outcome was defined as an admission to the intensive care unit because of complications of CDI, colectomy due to CDI, and/or death attributable to CDI.Results. A total of 1430 adults with HA CDI were identified in 29 hospitals during the 6-month surveillance period. The overall incidence rate of HA CDI for adult patients admitted to these hospitals was 4.6 cases per 1000 patient admissions and 65 per 100,000 patient-days. At 30 days after onset of HA CDI, 233 patients (16.3%) had died from all causes; 31 deaths (2.2%) were a direct result of CDI, and 51 deaths (3.6%) were indirectly related to CDI, for a total attributable mortality rate of 5.7%.Conclusions. The rates are remarkably similar to those found in our previous study; although we found wide variations in HA CDI among the participating hospitals. However, the attributable mortality increased almost 4-fold (5.7% vs. 1.5%;). P