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Two-year analysis of Clostridium difficile ribotypes associated with increased severity.
Journal of Hospital Infection ( IF 3.9 ) Pub Date : 2019-06-18 , DOI: 10.1016/j.jhin.2019.06.003
R Herbert 1 , J Hatcher 1 , E Jauneikaite 2 , M Gharbi 2 , S d'Arc 1 , N Obaray 3 , T Rickards 1 , M Rebec 1 , O Blandy 2 , R Hope 4 , A Thomas 2 , K Bamford 1 , A Jepson 1 , S Sriskandan 3
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BACKGROUND Certain Clostridium difficile ribotypes have been associated with complex disease phenotypes including recurrence and increased severity, especially the well-described hypervirulent RT027. This study aimed to determine the pattern of ribotypes causing infection and the association, if any, with severity. METHODS All faecal samples submitted to a large diagnostic laboratory for C. difficile testing between 2011 and 2013 were subject to routine testing and culture. All C. difficile isolates were ribotyped, and associated clinical and demographic patient data were retrieved and linked to ribotyping data. RESULTS In total, 86 distinct ribotypes were identified from 705 isolates of C. difficile. RT002 and RT015 were the most prevalent (22.5%, N=159). Only five isolates (0.7%) were hypervirulent RT027. Ninety of 450 (20%) patients with clinical information available died within 30 days of C. difficile isolation. RT220, one of the 10 most common ribotypes, was associated with elevated median C-reactive protein and significantly increased 30-day all-cause mortality compared with RT002 and RT015, and with all other ribotypes found in the study. CONCLUSIONS A wide range of C. difficile ribotypes were responsible for C. difficile infection presentations. Although C. difficile-associated mortality has reduced in recent years, expansion of lineages associated with increased severity could herald increases in future mortality. Enhanced surveillance for emerging lineages such as RT220 that are associated with more severe disease is required, with genomic approaches to dissect pathogenicity.

中文翻译:

艰难梭菌核型的两年分析与严重性增加相关。

背景技术某些艰难梭状芽胞杆菌核型已经与复杂的疾病表型相关,包括复发和严重性增加,特别是众所周知的高毒RT027。这项研究的目的是确定引起感染的核糖型的类型及其与严重性的关系。方法在2011年至2013年期间,所有提交至大型诊断实验室进行艰难梭菌检测的粪便样本均应进行常规检测和培养。所有艰难梭菌分离株均进行了核糖分型,并检索了相关的临床和人口统计学患者数据并将其与核糖分型数据关联。结果总共从705个艰难梭菌分离物中鉴定出86种不同的核糖型。RT002和RT015是最流行的(22.5%,N = 159)。RT027只有5株(0.7%)是高毒力的。450例(20%)具有临床信息的患者中有90例在艰难梭菌分离后30天内死亡。RT220是10种最常见的核糖型之一,与中位C反应蛋白升高有关,与RT002和RT015以及本研究中发现的所有其他核糖型相比,其30天全因死亡率显着增加。结论艰难梭菌的各种核糖型是造成艰难梭菌感染的原因。尽管近年来与艰难梭菌相关的死亡率有所降低,但与严重性增加有关的血统谱系的扩大可能预示着未来死亡率的增加。需要通过基因组方法来剖析致病性,以加强对与更严重疾病相关的新兴谱系(例如RT220)的监视。难隔离。RT220是10种最常见的核糖型之一,与RT-002和RT015以及本研究中发现的所有其他核糖型相比,中位C反应蛋白升高,且30天全因死亡率显着增加。结论艰难梭菌的各种核糖型是造成艰难梭菌感染的原因。尽管近年来与艰难梭菌相关的死亡率有所降低,但与严重性增加有关的血统谱系的扩大可能预示着未来死亡率的增加。需要通过基因组方法来剖析致病性,以加强对与更严重疾病相关的新兴谱系(例如RT220)的监视。难隔离。RT220是10种最常见的核糖型之一,与RT-002和RT015以及本研究中发现的所有其他核糖型相比,中位C反应蛋白升高,且30天全因死亡率显着增加。结论艰难梭菌的各种核糖型是造成艰难梭菌感染的原因。尽管近年来与艰难梭菌相关的死亡率有所降低,但与严重性增加有关的血统谱系的扩大可能预示着未来死亡率的增加。需要通过基因组方法来剖析致病性,以加强对与更严重疾病相关的新兴谱系(例如RT220)的监视。与RT002和RT015以及研究中发现的所有其他核糖型相比,C-反应蛋白中位数升高与30天全因死亡率显着增加有关。结论艰难梭菌的各种核糖型是造成艰难梭菌感染的原因。尽管近年来与艰难梭菌相关的死亡率有所降低,但与严重性增加相关的血统谱系的扩大可能预示着未来死亡率的上升。需要通过基因组方法来剖析致病性,以加强对与更严重疾病相关的新兴谱系(例如RT220)的监视。与RT002和RT015以及研究中发现的所有其他核糖型相比,C-反应蛋白中位数升高与30天全因死亡率显着增加有关。结论艰难梭菌的各种核糖型是造成艰难梭菌感染的原因。尽管近年来与艰难梭菌相关的死亡率有所降低,但与严重性增加有关的血统谱系的扩大可能预示着未来死亡率的增加。需要通过基因组方法来剖析致病性,以增强对与更严重疾病相关的新兴谱系(例如RT220)的监视。难治性相关死亡率近年来有所下降,与严重性增加相关的血统谱系的扩大可能预示着未来死亡率的增加。需要通过基因组方法来剖析致病性,以加强对与更严重疾病相关的新兴谱系(例如RT220)的监视。难治性相关死亡率近年来有所下降,与严重性增加相关的血统谱系的扩大可能预示着未来死亡率的增加。需要通过基因组方法来剖析致病性,以加强对与更严重疾病相关的新兴谱系(例如RT220)的监视。
更新日期:2019-11-27
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