在社区医院中，C. diff正在超越MRSA

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转中国医院感染管理网杨忠保老师的日志

C. diff Surpassing MRSA Infections in Community Hospitals
03/22/2010

While prevention methods appear to be helping to lower hospital infection rates from MRSA, a deadly antibiotic-resistant bacterium, a new superbug is on the rise, according to research from the Duke Infection Control Outreach Network.

New data shows infections from Clostridium difficile are surpassing methicillin-resistant Staphylococcus aureus (MRSA) infections in community hospitals.

“We found that MRSA infections have declined steadily since 2005, but C. difficile infections have increased since 2007,” said Becky Miller, MD, an infectious diseases fellow at Duke University Medical Center.

C. difficile is a multi-drug resistant bacterium that causes diarrhea and in some cases life-threatening inflammation of the colon. The infections are currently treated with one of two antibiotics. But relapses are common and occur in one-quarter of patients despite treatment, according to Miller.

“This is not a nuisance disease,” said Daniel Sexton, MD, director of the Duke Infection Control Outreach Network (DICON). “A small percentage of patients with C. difficile may die, despite treatment. Also, it is likely that the routine use of alcohol-containing hand cleansers to prevent infections from MRSA does not simultaneously prevent infections due to C. difficile.”

Miller and her team evaluated data from 28 hospitals in DICON, a collaboration between Duke and 39 community hospitals located in Georgia, North Carolina, South Carolina, and Virginia. The group tries to improve infection control programs by compiling data on infections occurring at member hospitals, identifying trends and areas for improvement, and providing ongoing education and leadership to community providers.

During a 24-month period, there were 847 cases of C. difficile infections in the 28 hospitals and the rate of C. difficile infection was 25 percent higher than the rate of infection due to MRSA.

Miller presented her findings at the Fifth Decennial International Conference on Healthcare-Associated Infections on March 20 in Atlanta.

“C. difficile is very common and deserves more attention,” she said. “Most people continue to think of MRSA as the big, bad superbug. Based on our data, we can see that this thinking, along with prevention methods, will need to change.”

In the past, hospitals were focused on MRSA and developed their prevention methods on MRSA as the issue, Sexton said.

“I have always thought that we need to be looking more globally at all the problems and this new information about C. difficile provides more data to support that,” he said.

C. difficile has been a low priority for hospitals, but now it is a relatively important priority, Sexton said.

“The key is to develop prevention methods aimed at C. difficile while still maintaining the success we have had with MRSA,” Miller said.

Source: Duke University Health System


在社区医院中，C. diff正在超越MRSA

2010年3月22日

感染的预防方法虽然看起来是帮助降低由MRSA，一个致命的抗生素耐药细菌医院感染率，根据杜克大学感染控制外联网络的研究，一个新的超级细菌正在上升。

新的数据显示，在社区医院中，艰难梭状芽胞杆菌感染正在超过耐甲氧西林金黄色葡萄球菌（MRSA）感染。

“我们发现，MRSA感染了自2005年以来持续下降，但梭状芽孢杆菌感染自2007年以来增加了，” Becky Miller, MD说，他在杜克大学医学中心研究感染性疾病。

C. difficile是一个多抗药性的细菌，可致腹泻并在某些情况下导致危及生命的结肠炎。感染的治疗，目前有两种抗生素。但据米勒说，复发是常见的，发生在1/4的经治病人中。

“这不是一个公害病，”杜克大学的感染控制外联网络（DICON）主任，Daniel Sexton, MD说。 “一小部分艰难梭菌患者虽经治疗，也可能会死亡。此外，可能常规用于防止MRSA感染的含酒精手消毒剂，不能同时防止梭状芽孢杆菌导致的感染。“

米勒和她的同事评估了28所DICON（杜克大学和39所位于佐治亚，北卡罗来纳，南卡罗来纳，弗吉尼亚州社区医院之间的协作网络）医院的数据。该小组织试图通过编制成员单位发生医院感染的数据，确定趋势和需要改进的领域，并提供持续教育和领导，以改进感染控制规划。

在24个月期间，28所医院中有847例的艰难梭菌感染，难辨梭状芽孢杆菌感染率比葡萄球菌感染率高了百分之25。

米勒在3月20日在亚特兰大召开的第五届医疗保健相关感染十年国际会议上发表了她的调查结果 “长梭状非常普遍，值得更多的注意”她说。 “大多数人仍然认为MRSA为大的，坏的超级病菌。根据我们的数据，我们可以看到这种想法，随同预防方法，都将需要改变”。

过去，医院将重点放在MRSA上，并发展相应的预防方法，Sexton说。“我一直认为我们必须对所有的问题有更全面的视角，这个关于艰难梭菌的新信息对此提供了更多的支持”他说。难辨梭菌在医院一直是低优先级的，但现在它是一个比较重要的优先事项，塞克斯顿说。“关键是保持我们在MRSA上取得的成功的同时，建立旨在预防梭状芽孢杆菌感染的方法”米勒说。

来源：杜克大学医疗中心

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    国内可能也很严重，但缺少数据？肠球菌的检出率国内低于西方，不是艰难梭菌检出如何？