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首页> 外文期刊>Journal of Clinical Microbiology >Characterization of Cases of Clostridium difficile Infection (CDI) Presenting at an Emergency Room: Molecular and Clinical Features Differentiate Community-Onset Hospital-Associated and Community-Associated CDI in a Tertiary Care Hospital
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Characterization of Cases of Clostridium difficile Infection (CDI) Presenting at an Emergency Room: Molecular and Clinical Features Differentiate Community-Onset Hospital-Associated and Community-Associated CDI in a Tertiary Care Hospital

机译：在急诊室就诊的难辨梭状芽胞杆菌感染（CDI）病例的特征：三级医院的社区和社区联合CDI和社区联合CDI有区别的分子和临床特征

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Definition of community-onset, hospital-acquired Clostridium difficile infection (CO-HA-CDI) is difficult in patients presenting with diarrhea at hospitals or outpatient clinics, especially 4 to 12 weeks after the last discharge. We performed C. difficile stool culture for 272 diarrheic patients visiting the emergency room (ER) between January 2006 and June 2010. C. difficile was isolated from 36 cases (13.2%), and isolation rates increased year by year, from 10.1% in 2008 to 12.4% in 2009 and 16.7% in 2010. Among 32 toxin-positive isolates, 13 (40.6%) and 19 (59.4%) were associated with CO-HA-CDI and community-acquired CDI (CA-CDI), respectively, if cases with CDI diagnosed within 12 weeks after discharge were considered hospital associated. The majority (70%) of CO-HA-CDI cases occurred within 2 weeks after hospital discharge, although the interval from discharge to onset of symptoms was as long as 10 weeks. We found via tcdA and tcdB and repetitive sequence PCR analysis, that toxin A-positive/toxin B-positive isolates were the most prevalent in both CO-HA-CDI (53.8%) and CA-CDI (94.7%) cases. Toxin A-negative/toxin B-positive isolates were also still highly associated with HA-CDI cases but were also observed in CA-CDI cases. Younger age, fewer underlying diseases, lack of prior antibiotic use, and genetic diversity of isolates in repetitive sequence PCR were the main characteristics in CA-CDI cases visiting the ER.
机译：对于在医院或门诊出现腹泻的患者，尤其是最后一次出院后的4至12周，很难确定社区发作的医院获得性艰难梭菌感染（CO-HA-CDI）。在2006年1月至2010年6月之间，我们对272名来急诊室（ER）的腹泻患者进行了艰难梭菌粪便培养。艰难梭菌被分离出36例（13.2％），分离率逐年提高，从2006年的10.1％上升。 2008年至2009年为12.4％，2010年为16.7％。在32种毒素阳性菌株中，分别有13种（40.6％）和19种（59.4％）与CO-HA-CDI和社区获得的CDI（CA-CDI）相关。 ，如果出院后12周内诊断出患有CDI的病例被认为与医院有关。尽管从出院到症状发作的间隔长达10周，但大多数（70％）CO-HA-CDI病例发生在出院后2周内。我们通过 tcdA 和 tcdB 以及重复序列PCR分析发现，毒素A阳性/毒素B阳性分离株在两种CO-HA-CDI中最为普遍（53.8 ％）和CA-CDI（94.7％）的案例。毒素A阴性/毒素B阳性分离株仍与HA-CDI病例高度相关，但在CA-CDI病例中也观察到。年龄较小，基础疾病较少，以前没有使用抗生素以及重复序列PCR中分离株的遗传多样性是前往ER的CA-CDI病例的主要特征。

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