Recurrence of symptoms in Clostridium difficile infection - relapse or reinfection?
Recurrence of symptoms in Clostridium difficile infection - relapse or reinfection?
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DOI：
10.1016/s0195-6701(98)90062-7
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发表时间：
1998-02-01
影响因子：
6.9
通讯作者：
Davidson, A
中科院分区：
文献类型：
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作者：
Wilcox, MH;Fawley, WN;Davidson, A
我们使用随机扩增多态性DNA（RAPD）对有症状复发的感染患者的艰难梭菌分离株进行了指纹图谱分析。对79例患者中的55例进行了病历检查，其中多个C。在住院期间接受艰难梭菌阳性粪便，间隔至少5天，但不超过2个月。在这些病例中，有20例症状没有复发（即，发作之间至少3天未出现），或可由其他原因解释，如给予泻药。其余35例患者中，27例C.艰难梭菌分离株（23对和4个三重）可用于RAPD指纹图谱。迪弗林角从15/27名患者中获得了艰难的DNA指纹（至少三个主要条带差异），因此至少56%的感染临床复发实际上是由于再感染而不是复发。自从我们发现一个地方性的C. 27例患者中有18例（67%）存在艰难梭菌克隆，占所有分离株的53%（31/58），大多数有症状的复发可能实际上是不同或相同C.艰难菌株提示应加强对C.有症状的患者。隔离有症状的个体是保护其他患者的首选方案，但必须采取措施确保指示病例不会发生进一步的菌株感染。
We have fingerprinted Clostridium difficile isolates from patients with symptomatic recurrences of infection, using random amplified polymorphic DNA (RAPD). The medical records of 55/79 patients were examined, from whom multiple C. difficile-positive faeces were received during hospitalization at least five days, but no more than two months, apart. In 20 of these cases symptoms either did not recur (i.e., absent for at least three days between episodes), or were explainable by other causes, such as laxative administration. Of the remaining 35 patients, 27 sets of C. difficile isolates (23 pairs and four triplicates) were available for RAPD fingerprinting. Differing C. difficile DNA fingerprints (at least three major bands difference) were obtained for 15/27 patients, and hence at least 56% of the clinical recurrences of infection were in fact due to re-infection as opposed to relapse. Since we found that an endemic C. difficile clone was present in 18 out of 27 patients (67%) and accounted for 53% (31/58) of all isolates, it is probable that the majority of symptomatic recurrences are in fact re-infections, with either a different or the same C. difficile strain. We conclude that more attention must be given to preventing the re-infection of C. difficile symptomatic patients. Isolation of symptomatic individuals is the preferred option for the protection of other patients, but measures must be taken to ensure that further strain acquisition by the index cases does not occur.