艰难梭菌流行病学国内外研究进展

正艰难梭状芽孢杆菌(Clostridium difficile,CD)简称艰难梭菌,属于厌氧芽孢梭菌属,革兰染色阳性,粗大形杆菌(长3.0~16.9μm,宽0.5~1.9μm),有鞭毛,能形成芽孢[1]。CD于1935年由Hall和O’Toole第一次从婴儿的粪便中分离得到。1978年George第一次报道CD与人类假膜型结肠炎相关,患者在使用抗菌药物后发生由CD导致的     

ICU艰难梭菌感染及其影响因素分析

目的了解医院ICU腹泻患者艰难梭菌感染(Clostridium difficile infection,CDI)的发病率及其影响因素,为临床诊治提供一定参考价值。方法联合梅里埃miniVIDAS酶联荧光法和Gene Xpert~?C.difficile实时荧光PCR法的新鲜便标本检测结果,诊断CDI,回顾性收集患者临床资料并分析其影响因素。结果 ICU住院腹泻患者CDI的发病率为16.9%(10/59)。血钾浓度、促胃肠动力药物和万古霉素与CDI有关(P<0.05)。Logistic回归分析显示,促胃肠蠕动药物是CDI的独立影响因素;万古霉素是CDI的独立预防因素。结论可考虑将CDI检测作为ICU患者的常规检查;促胃肠蠕动药物是否会引起CDI仍需进一步研究。     

艰难梭菌感染研究进展

<正>凡不能用其他原因解释的腹泻(稀便≥3次/24h),加上粪便中检测出艰难梭菌(Clostridium difficile,CD)及其毒素,或结肠镜和组织学检查证实为假膜性结肠炎均可确诊为CD感染(Clostridium difficile infection,CDI)[1]。CD是引起抗菌药物相关性腹泻最常见的病原体,约占抗菌药物相关性腹泻的10%~30%。近年来,毒力更强的BI/     

艰难梭菌感染诊断(T/CPMA 008-2020)

前言本标准按照GB/T 1.1-2009给出的规则起草。本标准由中华预防医学会归口。本标准起草单位:中国疾病预防控制中心传染病预防控制所、中国人民解放军总医院、云南省疾病预防控制中心、中国医学科学院北京协和医院、中南大学湘雅医院、复旦大学附属华山医院、四川大学华西医院、杭州医学院、河北医科大学第二医院、南方医科大学南方医院、内蒙古自治区人民医院、山东省立医院。     

社区获得性感染和医院获得性感染发生率分析

医院感染是许多疾病的主要并发症之一,影响患者的预后及转归,也是影响医院医疗质量的一个重要因素.本文就我院2003年1～6月份呼吸内科病房的住院病例进行分析,了解社区获得性感染和医院获得性感染的发生率和死亡率.     

神经外科住院患者定植及感染产毒艰难梭菌的分子流行病学特征

目的 研究神经外科住院患者定植及感染产毒艰难梭菌的分子流行病学特征。方法 采用前瞻性研究方法,选取2018年11月-2019年4月所有徐州医科大学附属医院神经外科新入院的成年患者161例为研究对象。在入院后48 h内、入院后每周及发生腹泻时分别采集粪便标本,本研究的主要临床结局是发生艰难梭菌感染(CDI),未发生CDI的患者随访至出院或死亡。对采集的粪便标本进行艰难梭菌培养及毒素基因检测,对所有的产毒艰难梭菌进行多位点序列分型。结果 从41名患者的粪便中培养分离出产毒艰难梭菌共计50株,其中,30株菌株tcdA及tcdB阳性,占60.00%;17株菌株仅tcdB阳性,占34.00%;3株菌株tcdA、tcdB及cdtA-cdtB均阳性,占6.00%。7名患者发生CDI,CDI发病率为4.35%,其中6名患者在入院时定植产毒艰难梭菌。将分离的50株产毒艰难梭菌进行多位点序列分型,共分析出14个ST分型,其中3株二元毒素阳性菌株均为ST5型。研究期间,患者4与患者31、患者13与患者19检测到相同的ST型,且居住过同一病房或床位。结论 本研究未分离到高毒力菌株ST1/RT027型或ST11...     

艰难梭菌分子分型方法研究进展

正艰难梭菌(Clostridium difficile,CD)是一种革兰阳性厌氧芽孢杆菌,20世纪80年代发现它是引起抗生素相关性假膜性肠炎的原因之一,由其引起的艰难梭菌感染(Clostridium difficile infection,CDI)现已成为抗生素相关性腹泻的主要原因[1-2]。CDI可表现为从轻度的自限性腹泻到严重     

艰难梭菌感染诊断团体标准解读

艰难梭菌是引起抗生素相关性腹泻和医疗机构相关性腹泻的重要病原,在欧美引起暴发流行,造成沉重疾病负担。然而我国艰难梭菌感染调查缺乏统一的诊断原则和检测技术规范,我国艰难梭菌感染率和疾病负担尚不明确。因此中国CDC传染病预防控制所联合全国其他11家单位撰写《艰难梭菌感染诊断（T/CPMA 008-2020）》中华预防医学会...     

机械通气患者艰难梭菌感染危险因素及临床预后分析

目的探讨艰难梭菌感染(Clostridium difficile infection,CDI)在机械通气患者发生的危险因素并评估CDI对临床预后的影响。方法选择医院2014年4月-2016年4月收治577例机械通气患者,并根据有无CDI分为CDI感染组(54例)和CDI非感染组(523例),对机械通气患者CDI的危险因素进行分析,并比较两组患者入院30d内生存率的差异。结果 577例机械通气患者中有54例CDI,感染率为9.36%;机械通气患者CDI与性别、基础疾病类型及大多数并存症无显著相关性,患者年龄≥70岁、入ICU时APACHEⅡ评分高、住院时间长、住ICU时间长、机械通气时间长等CDI感染率较高,差异有统计学意义(P<0.05);logistic多因素回归分析发现,CDI危险因素包括年龄,入ICU时APACHEⅡ评分,使用抑酸剂以及机械通气前抗菌药物使用种类(≥3种);机械通气CDI与非感染患者入院30d内生存率差异无统计学意义。结论 CDI在机械通气患者中比较常见,且能明显延长住院时间、ICU住院时间和机械通气时间,熟悉CDI危险因素可能有助于降低CDI的感染率。     

艰难梭菌医院感染及预防控制研究进展

艰难梭菌是引起医源性肠道感染的重要致病菌,临床表现为腹痛、腹泻、肠炎等,严重者可并发低血压、休克及腹腔感染,且存在复发性感染的风险,对患者的生活质量造成显著的负面影响。随着抗菌药物的广泛使用,艰难梭菌感染的发病率逐年上升,复发及死亡人数也随之上升,其感染的预防控制需要引起足够的重视。本研究综述艰难梭菌感染的流行病学、危险因素、诊断及治疗,并探讨其预防控制策略,为进一步预防控制提供参考借鉴。     

ICU艰难梭菌定植与感染的危险因素研究

目的探讨重症监护室(ICU)艰难梭菌定植与感染患者的危险因素,为实施有效的防控方案提供依据。方法采用前瞻性研究方法,连续收集2017年1月1日-2018年6月1日入住某院ICU患者的临床资料,采集患者粪便及其周围环境标本进行艰难梭菌检测,分析影响因素。结果多因素Logistic回归分析结果显示,年龄、质子泵抑制剂、侵入性操作、机械通气、糖尿病和β-内酰胺酶抑制剂使用是艰难梭菌的感染和定植的危险因素。结论对CDI患者进行隔离,对高龄、侵入性操作、机械通气、合并糖尿病及使用β-内酰胺酶抑制剂、质子泵抑制剂等艰难梭菌感染高危因素的患者密切关注;加强环境表面清洁消毒工作,降低艰难梭菌芽孢传播的风险,为今后研究制定艰难梭菌感染防控措施提供依据。     

Risk factors for Clostridium difficile toxin-associated diarrhea

The hospital-wide attack rate for Clostridium difficile-associated diarrhea at our tertiary-care university hospital was 0.02 per 100 patient discharges (0.02%) in 1982, but 0.41% and 1.47% in 1986 and 1987, respectively, with a peak incidence of 2.25% in the fourth quarter of 1987. Hospital antibiotic usage patterns showed concurrent increased use of third-generation cephalosporins, and intravenous vancomycin and metronidazole. Thirty-seven cases selected for study were older than 37 control patients, more likely to have an underlying malignancy and less likely hospitalized on the obstetrics/gynecology service. Their mean duration of hospitalization prior to diagnosis was 21 days, versus a mean total length of stay of eight days for controls. All cases received antibiotics, compared to 24 of the controls. Cases were given more antibiotics for longer periods, and more often received clindamycin, third-generation cephalosporins, aminoglycosides and vancomycin. Gender, race, duration of hospitalization, prior surgery and antiulcer therapy were not significant by logistic regression analysis. Epidemiologic variables with significantly different adjusted odds ratios (95% confidence intervals) were age greater than 65 years (14.1, 1.4-141), intensive care unit residence (39.2, 2.2-713), gastrointestinal procedure (23.2, 2.1-255) and more than ten antibiotic days (summation of days of each antibiotic administered) (16.1, 2.2-117). Control measures included encouraging earlier isolation and treatment of suspected cases and formulary restriction of clindamycin, with use of metronidazole for therapy of anaerobic infections. By the second half of 1988, the attack rate had dropped progressively to 0.74%.     

Epidemiology of Clostridium difficile infection

Pseudomembranous colitis (PMC), antibiotic-associated diarrhoea (AAD), and colitis (AAC) caused by Clostridium difficile are recognized as complications of antibiotic treatment (cephalosporins, penicillins, clindamycin and others). Two groups are particularly at risk: older and immunocompromised patients. In recent years C. difficile has been recognized as a common nosocomial pathogen. To understand the epidemiology of the C. difficile infection, many outbreaks have been investigated by various methods. In the paper we reviewed different methods of C. difficile typing and discussed the epidemiology of C. difficile-associated infections in light of recent publications.     

Meta-analysis to assess risk factors for recurrent Clostridium difficile infection

SUMMARY: Clostridium difficile infection (CDI) is the most common cause of hospital-acquired diarrhoea. It is estimated that 15-20% of patients experience recurrence of CDI. A limited number of studies have looked at the risk factors for recurrent CDI. We conducted a meta-analysis of observational studies and randomised controlled trials (RCTs) to assess risk factors for recurrent CDI. Studies were identified using the PubMed database and search terms 'Clostridium difficile associated diarrhoea' or 'pseudomembranous colitis'. Both observational studies and RCTs were included. In all, 1215 studies were identified of which 48 met the inclusion criteria. Twelve studies involving 1382 patients with CDI met the complete eligibility requirements. Odds ratios and information on study quality were abstracted by two investigators independently. To be included in the analysis, each risk factor was required to be evaluated by at least three separate studies. Continued use of non-C. difficile antibiotics after diagnosis of CDI (OR: 4.23; 95% CI: 2.10-8.55; P<0.001), concomitant receipt of antacid medications (OR: 2.15; 95% CI: 1.13-4.08; P=0.019), and older age (OR: 1.62; 95% CI: 1.11-2.36; P=0.0012) were significantly associated with increased risk of recurrent CDI. Significant prognostic risk factors were identified as risk factors for CDI recurrence. Additional or novel interventions may be required for these patients to prevent CDI recurrence.