Molecular Epidemiology of Hospital-Associated and Community-Acquired Clostridium difficile Infection in a Swedish County

摘要: All episodes of Clostridium difficile associated diarrhea (CDAD) diagnosed in a defined population 274,000 including one tertiary and two primary hospitals their catchment areas were studied during 12 months. The annual CDAD incidence the county was 97 per 100,000, 78% all classified as hospital with mean 5.3 (range, 1.4 to 6.5) 1,000 admissions. among hospitalized individuals 1,300-fold higher than that community (33,700 versus 25 100,000 persons year), reflecting 37-fold difference antibiotic consumption (477 13 daily doses [DDD]/1,000 persons/day) other risk factors. Three wards highest (13 36 1,000) had patients high age (median 80 years 70 for wards, P < 0.001), long stay (up days 4 days), or rate 2,427 421 DDD/1,000 bed days). PCR ribotyping C. isolates available from 330 372 indicated nosocomial acquisition strain 17 27% hospital-associated cases, depending on time interval between index secondary cases allowed (2 months up months), only 10% recurrences due new (apparent reinfection). In words, most recurring apparently caused by patient's endogenous rather origin. Typing also majority strains belonged international serotypes, distribution types similar within outside relapsing CDAD. However, type SE17 an exception, comprising 22% compared 6% (P = 0.008) causing many minor clusters silent outbreak 44% three high-incidence wards.