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。
References
- Lucado J, Gould C, Elixhauser A. Clostridium difficile infections (CDI) in hospital stays, 2009. HCUP statistical brief no. 124. Rockville, MD: US Department of Health and Human Services, Agency for Healthcare Research and Quality; 2011. Available at <http://www.hcup-us.ahrq.gov/reports/statbriefs/sb124.pdf>. Accessed February 2, 2012.
- CDC. Vital signs: central line-associated blood stream infections- United States, 2001, 2008, and 2009. MMWR 2011;60:243-8.
- Cohen SH, Gerding DN, Johnson S, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). Infect Control Hosp Epidemiol 2010;31:431-55.
- Butler M, Bliss D, Drekonja D, et al. Effectiveness of early diagnosis, prevention, and treatment of Clostridium difficile infection. Rockville, MD: US Department of Health and Human Services, Agency for Healthcare Research and Quality; 2011. Available at http://www.effectivehealthcare.ahrq.gov/ehc/products/115/822/cer-31_cdiff_execsummary_20111220.pdf. Accessed March 1, 2012.
- CDC. EIP surveillance methodology for Clostridium difficile infections. Atlanta, GA: US Department of Health and Human Services, CDC; 2012.
- McDonald LC, Coignard B, Dubberke E, Song X, Horan T, Kutty PK. Recommendations for surveillance of Clostridium difficile-associated disease. Infect Control Hosp Epidemiol 2007;28:140-5.
- National Healthcare Safety Network. Multidrug-resistant organism and Clostridium difficile infection (MDRO/CDI) module. Atlanta, GA: US Department of Health and Human Services, CDC; 2009. Available at <http://www.cdc.gov/nhsn/mdro_cdad.html>. Accessed February 2, 2012.
- CDC. Reduction in central line-associated bloodstream infections among patients in intensive care units-Pennsylvania, April 2001-March 2005. MMWR 2005;54:1013-6.
- McDonald LC, Killgore GE, Thompson A, et al. An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med 2005;353:2433-41.
- Hall AC, Curns AT, McDonald LC, Parashar UD, Lopman BA. The roles of norovirus and Clostridium difficile among gastroenteritis deaths in the United States, 1999-2007. Presentation at the 49th Annual Meeting of the Infectious Disease Society of America; October 22, 2011; Boston, MA.
- Dubberke ER, Reske KA, Olsen MA, McDonald LC, Fraser VJ. Short- and long-term attributable costs of Clostridium difficile-associated disease in nonsurgical inpatients. Clin Infect Dis 2008;46:497-504.
- Warny M, Pepin J, Fang A, et al. Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe. Lancet 2005;366:1079-84.
- Duerden BI. Contribution of a government target to controlling Clostridium difficile in the NHS in England. Anaerobe 2011;17:175-9.
- Health Protection Agency (United Kingdom). Quarterly epidemiological commentary: mandatory MRSA & MSSA bacteraemia, and Clostridium difficile infection data (up to July - September 2011). London, England: Health Protection Agency; 2011. Available at <http://www.hpa.org.uk/webc/hpawebfile/hpaweb_c/1284473407318>. Accessed February 2, 2012.
- US Department of Health and Human Services. HHS action plan to prevent healthcare-associated infections. Washington, DC: US Department of Health and Human Services; 2009. Available at <http://www.hhs.gov/ash/initiatives/hai/actionplan>. Accessed February 2, 2012.
- Hensgens MP, Goorhuis A, Dekkers OM, Kuijper EJ. Time interval of increased risk for Clostridium difficile infection after exposure to antibiotics. J Antimicrob Chemother 2011; December 6 [Epub ahead of print].
- Swindells J, Brenwald N, Reading N, Oppenheim B. Evaluation of diagnostic tests for Clostridium difficile infection. J Clin Microbiol 2010;48:606-8.
- Zilberberg MD, Tabak YP, Sievert DM, et al. Using electronic health information to risk-stratify rates of Clostridium difficile infection in US hospitals. Infect Control Hosp Epidemiol 2011;32:649-55.
- Centers for Medicare & Medicaid Services. Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and FY 2012 rates; hospitals’ FTE resident caps for graduate medical education payment. Baltimore, MD: US Department of Health and Human Services, Centers for Medicare & Medicaid Services; 2011. Available at <http://www.cms.gov/acuteinpatientpps/fr2012/itemdetail.asp?itemid=cms1250103>. Accessed February 2, 2012.
Copyright © 2013 International Medical Information Center. All Rights Reserved.