Clostridium difficile Infection
Health Care–Associated Clostridium difficile Infection in Canada: Patient Age and Infecting Strain Type Are Highly Predictive of Severe Outcome and Mortality加拿大一项有关艰难梭菌感染的研究表明：患者年龄和感染菌株的类型可用来预测其后果及死亡率。
Background. C. difficile infection (CDI) has become an important and frequent nosocomial infection, often resulting in severe morbidity or death. Severe CDI is more frequently seen among individuals infected with the emerging NAP1/027/BI (NAP1) strain and in the elderly population, but the relative importance of these 2 factors remains unclear. We used a large Canadian database of patients with CDI to explore the interaction between these 2 variables.
背景艰难梭菌感染（CDI）已经成为一种重要的医院感染，发病率较高，常常引起患者死亡。严重的CDI常见于NAP1/027/BI（NAP1）株感染以及老年人群中，但尚并不清楚这两个因素哪个更为重要。为此，我们对来自加拿大CDI患者的大量资料进行了分析。
Methods. The Canada-wide CDI study, performed in 2005 by the Canadian Nosocomial Infection Surveillance Program (CNISP), was used to analyze the role of infecting strain type and patient age on the severity of CDI. A severe outcome was defined as CDI requiring intensive care unit care, colectomy, or causing death (directly or indirectly) within 30 days after diagnosis.
方法研究资料来自2005年加拿大医院感染监控计划（CNISP）进行的全国CDI研究项目，用于分析感染菌株的类型和病人年龄对CDI的严重性所起的作用。“严重后果”是指CDI患者者需要转入重症监护病房、施行结肠切除术或在诊断后30天内死亡（直接或间接）。
Results. A total of 1008 patients in the CNISP database had both complete clinical data and infecting strain analysis documented. A total of 311 patients (31%) were infected with the NAP1 strain, 83 (28%) were infected with the NAP2/J strain, and the rest were infected with various other types. The proportion of NAP1 infections correlated with the incidence and the severity of CDI when analyzed by province. Thirty-nine (12.5%) of the infections due to the NAP1 strain resulted in a severe outcome, compared with only 41 (5.9%) of infections due to the other types (P＜0.001 ). The patient’s age was strongly associated with a severe outcome, and patients 60–90 years of age were approximately twice as likely to experience a severe outcome if the infection was due to NAP1, compared with infections due to other types.
结果在CNISP资料中，一共有1008例患者具备完整的临床资料和感染菌株分型结果。其中311例（31％）感染的是NAP1株，83例（28％）为NAP2/J株，其余为其它各种不同菌株感染。按省（地区）进行分析发现，NAP1感染的比例与CDI严重后果的发生率及严重程度相关。NAP1感染者中39例（12.5％）出现严重后果，而其它菌株感染者中仅有41例（5.9％）(P＜0.001 )。此外，患者的年龄与之也有较强的关联，60-90岁的患者感染NAP1株后出现严重后果的人数是感染其它菌株的两倍左右。
Conclusions. Our study confirms the strong age association with infection due to the NAP1 strain and severe CDI. In addition, patients 60–90 years of age infected with NAP1 are approximately twice as likely to die or to experience a severe CDI-related outcome, compared with those with non-NAP1 infections. Patients 190 years of age experience high rates of severe CDI, regardless of strain type.
结论我们的研究表明，患者年龄与NAP1株引起的CDI及其严重程度密切相关。另外，60-90岁的患者因感染NAP1株导致死亡及出现严重后果的几率大约是其它菌株感染的2倍。无论是哪种菌株引起的CDI，大于90岁的患者极易出现严重后果。 感谢mache 版主，这篇文章非常好，很有临床指导价值
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