PDF(Pubmed)
Abstract：
Clostridioides difficile infection (CDI) has become the most common healthcare-associated infection in the United States, with considerable morbidity, mortality, and healthcare costs. Assessing new preventive strategies is vital. We present a literature review of studies evaluating a strategy of screening and isolation of asymptomatic carriers in hospital settings. Asymptomatic detection of C. difficile is reported in ~ 10-20% of admitted patients. Risk factors for carriage include recent hospitalization, previous antibiotics, older age, lower functional capacity, immunosuppression, and others. Asymptomatic C. difficile carriers of toxigenic strains are at higher risk for progression to CDI. They are also shedders of C. difficile spores and may contribute to the persistence and transmission of this bacterium. Screening for asymptomatic carriers at hospital admission can theoretically reduce CDI by isolating carriers to reduce transmission, and implementing antibiotic stewardship measures targeting carriers to prevent progression to clinical illness. Several observational studies, summarized in this review, have reported implementing screening and isolation strategies, and found a reduction in CDI rates. Nevertheless, the data are still limited to a few observational studies, and this strategy is not commonly practiced. Studies supporting screening were performed in North America, coinciding with the period of dominance of the 027/BI/NAP1 strain. Additional studies evaluating screening, followed by infection control and antibiotic stewardship measures, are needed.
摘要：
艰难梭菌感染（CDI）已成为美国最常见的医疗保健相关感染，发病率相当高，死亡率,和医疗费用。评估新的预防策略至关重要。我们对评估医院环境中无症状携带者的筛查和隔离策略的研究进行了文献综述。在约10-20%的入院患者中报道了艰难梭菌的无症状检测。运输的危险因素包括最近住院，以前的抗生素，年龄较大,较低的功能容量，免疫抑制,和其他人。产毒菌株的无症状艰难梭菌携带者进展为CDI的风险较高。它们也是艰难梭菌孢子的脱落者，可能有助于这种细菌的持久性和传播。入院时筛查无症状携带者理论上可以通过隔离携带者以减少传播来降低CDI,并实施针对携带者的抗生素管理措施，以防止进展为临床疾病。一些观察性研究，在这篇综述中总结，已经报告实施了筛查和隔离策略，并发现CDI率降低。然而，数据仍然限于一些观察性研究，这种策略并不常见。支持筛查的研究在北美进行，与027/BI/NAP1菌株的优势期一致。评估筛查的其他研究，其次是感染控制和抗生素管理措施，是需要的。
