Background

Although population characteristics and antimicrobial prescribing practices suggest that the hospitalized population in Japan is at high risk of Clostridioides difficile infection (CDI), the epidemiology of CDI in Japan is poorly understood.

Aim

This prospective cohort study aimed to investigate the epidemiology of CDI at twelve hospitals in Japan.

Methods

Patients with clinically significant diarrhoea (CSD) were enrolled. Stool specimens were tested for C. difficile by toxin A and/or B enzyme immunoassay (EIA) in the hospital laboratories, and a toxigenic culture and nucleic acid amplification tests were performed at a central laboratory. The risk factors of CDI and the impact of CDI on mortality were investigated.

Findings

In total, 566 patients with CSD were included in the analyses. A total of 152 patients received the diagnosis of CDI by Toxin A/B EIA. Factors associated with CDI included low albumin (aOR 1.56; 95% CI 1.03 – 2.34) and length of hospital stay before stool collection >18 days (aOR 1.73; 95% CI 1.09-2.75). CDI was associated with an increased mortality on univariate analysis (OR 1.6, 95% CI 1.0-2.6) but was not associated with an increased risk of mortality on multivariable analysis.

Conclusion

Risk factors for CDI in Japan were similar to those identified in the US and Europe. However, CDI was not associated with an increased risk of mortality in this population of patients with CSD.

中文翻译：

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日本住院患者难辨梭状芽胞杆菌感染的危险因素及相关死亡率：一项多中心前瞻性队列研究

背景

尽管人口特征和抗菌药物处方规范表明日本的住院人口极易发生艰难梭菌感染（CDI），但对日本CDI的流行病学了解甚少。

目的

这项前瞻性队列研究旨在调查日本12家医院CDI的流行病学。

方法

纳入具有临床显着性腹泻（CSD）的患者。在医院实验室中通过毒素A和/或B酶免疫测定（EIA）测试了粪便样品中的艰难梭菌，并在中心实验室进行了产毒培养和核酸扩增测试。研究了CDI的危险因素以及CDI对死亡率的影响。

发现

分析共纳入566名CSD患者。共有152例患者通过毒素A / B EIA诊断为CDI。与CDI相关的因素包括白蛋白水平低（aOR 1.56; 95％CI 1.03 – 2.34）和粪便收集前住院天数> 18天（aOR 1.73; 95％CI 1.09-2.75）。CDI与单因素分析的死亡率增加相关（OR 1.6，95％CI 1.0-2.6），但与多变量分析的死亡率增加无关。

结论

日本CDI的风险因素与美国和欧洲的风险因素相似。但是，CDI与这种CSD患者的死亡风险增加无关。