NEJM论文]：美国难辨梭状芽孢杆菌的发病率
：美国难辨梭状芽孢杆菌的发病率
2015年03月27日 ⁄ 时讯速递, 进展交流 ⁄ 暂无评论
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ORIGINAL ARTICLE
Burden of Clostridium difficile Infection in the United States
Fernanda C. Lessa, M.D., M.P.H., Yi Mu, Ph.D., Wendy M. Bamberg, M.D., Zintars G. Beldavs, M.S., Ghinwa K. Dumyati, M.D., John R. Dunn, D.V.M., Ph.D., Monica M. Farley, M.D., Stacy M. Holzbauer, D.V.M., M.P.H., James I. Meek, M.P.H., Erin C. Phipps, D.V.M., M.P.H., Lucy E. Wilson, M.D., Lisa G. Winston, M.D., Jessica A. Cohen, M.P.H., Brandi M. Limbago, Ph.D., Scott K. Fridkin, M.D., Dale N. Gerding, M.D., and L. Clifford McDonald, M.D.
N Engl J Med 2015; 372:825-834February 26, 2015DOI: 10.1056/NEJMoa1408913
ABSTRACT
背景(BACKGROUND)
美国难辨梭状芽孢杆菌感染率持续增加。
The magnitude and scope of Clostridium difficile infection in the United States continue to evolve.
方法(METHODS)
2011年，我们在美国10个地区进行了基于人口及实验室的调查，以鉴别难辨梭状芽孢杆菌感染病例（年龄≥ 1岁的居民粪便标本难辨梭状芽孢杆菌毒素检测或分子检测阳性）。病例分为社区相关性或医院相关性。对于感染病例，我们进行标本培养，且对分离株进行分子分型。我们采用回归模型计算全国发病率及感染人数，首次复发率以及诊断难辨梭状芽孢杆菌感染30天内的病死率。
In 2011, we performed active population- and laboratory-based surveillance across 10 geographic areas in the United States to identify cases of C. difficile infection (stool specimens positive for C. difficile on either toxin or molecular assay in residents ≥1 yearar of age). Cases were classified as community-associated or health care–associated. In a sample of cases of C. difficile infection, specimens were cultured and isolates underwent molecular typing. We used regression models to calculate estimates of national incidence and total number of infections, first recurrences, and deaths within 30 days after the diagnosis of C. difficile infection.
结果(RESULTS)
在10个地区共发现15461例难辨梭状芽孢杆菌感染病例；65.8%为医院相关性，但仅有24.2%在住院期间发病。根据疾病发病率的预测因素进行校正后，美国难辨梭状芽孢杆菌感染的年发病人数为453000（95%可信限 397100-508500）。女性（发病率比值1.26；95%CI 1.25-1.27）、白种人（发病率比值1.72；95%CI 1.56-2.0）和65岁以上人群（发病率比值8.65；95%CI 8.16-9.31）发病率更高。首次复发的感染病例为83000例（95%CI 57000-108900），死亡病例数约为29300（95%CI 16500-42100）。与社区相关性感染相比，医院相关性感染中北美脉冲场凝胶电泳1型(NAP1)更为常见(30.7% vs. 18.8%, p < 0.001)。
A total of 15,461 cases of C. difficile infection were identified in the 10 geographic areas; 65.8% were health care–associated, but only 24.2% had onset during hospitalization. After adjustment for predictors of disease incidence, the estimated number of incident C. difficile infections in the United States was 453,000 (95% confidence interval , 397,100 to 508,500). The incidence was estimated to be higher among females (rate ratio, 1.26; 95% CI, 1.25 to 1.27), whites (rate ratio, 1.72; 95% CI, 1.56 to 2.0), and persons 65 years of age or older (rate ratio, 8.65; 95% CI, 8.16 to 9.31). The estimated number of first recurrences of C. difficile infection was 83,000 (95% CI, 57,000 to 108,900), and the estimated number of deaths was 29,300 (95% CI, 16,500 to 42,100). The North American pulsed-field gel electrophoresis type 1 (NAP1) strain was more prevalent among health care–associated infections than among community-associated infections (30.7% vs. 18.8%, P
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