バイタルサイン:クロストリジウム感染症の予防

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ホーム IMICライブラリ MMWR抄訳 2012年（Vol.61)バイタルサイン:クロストリジウム感染症の予防

MMWR抄訳

2012/03/09Vol. 61 / No. 9

MMWR61(9):157－162
Vital Signs: Preventing Clostridium difficile Infections

バイタルサイン:クロストリジウム感染症の予防

クロストリジウムディフィシル感染症(CDI)は医療関連感染症であり、抗生物質の投与を受ける入院患者における発症率および死亡率が高い。救急病院(n=111)および療養施設(n=310)におけるEmergency Infections Programデータより、CDIs患者10,342例(65歳未満:44%)を便検体採取時の状態から1)院内発症CDI:入院から3日以上経過して採取した検体が陽性を示した入院患者、2)療養施設発症CDI:療養施設滞在中に検体が陽性を示した症例、3)市中発症CDI:外来患者または入院から3日以内に検体が陽性を示した入院患者に分類した結果、これら医療関連発症例が94%を占め(1:45%、2:25%、3:24%)、うち75%が院外での発症であり、院内発症例の20%は入院から12週未満での発症、療養施設発症例の67%は救急病院からの転院例であった。また、National Healthcare Safety Network (NHSN)に報告された28州711救急病院における研究室レベでのCDI確診例(LabID-CDI)は2010年にて計42,157例であり、うち52%は入院時にすでに発症していた。イリノイ、マサチューセッツ、ニューヨーク州の蓄積データ分析では、CDCの予防プログラムに参加している71病院における院内発症率は2008年から2010年にかけて20%低下していた(10,000例/日あたり9.3から)。以上、CDIのほぼ全例が医療施設に関連して発症しており、感染コントロールおよび医療施設および療養施設での抗生物質処方の見直しによりCDIの発症は予防しうると考えられ、また、早期診断および症例の隔離なども重要である。

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