Abstract：
In contrast to the epidemiology 10 years earlier at our hospital when the epidemic restriction endonuclease analysis (REA) group strain BI accounted for 72% of Clostridioides difficile isolates recovered from first-episode C. difficile infection (CDI) cases, BI represented 19% of first-episode CDI isolates in 2013-2015. Two additional REA group strains accounted for 31% of isolates (Y, 16%; DH, 12%). High-level resistance to fluoroquinolones and azithromycin was more common among BI isolates than among DH, Y, and non-BI/DH/Y isolates. Multivariable analysis revealed that BI cases were 2.47 times more likely to be associated with fluoroquinolone exposure compared to non-BI cases (95% confidence interval [CI]: 1.12-5.46). In addition, the odds of developing a CDI after third- or fourth-generation cephalosporin exposure was 2.83 times for DH cases than for non-DH cases (95% CI: 1.06-7.54). Fluoroquinolone use in the hospital decreased from 2005 to 2015 from a peak of 113 to a low of 56 antimicrobial days/1,000 patient days. In contrast, cephalosporin use increased from 42 to 81 antimicrobial days/1,000 patient days. These changes correlated with a decrease in geometric mean MIC for ciprofloxacin (61.03 to 42.65 mg/L, P = 0.02) and an increase in geometric mean MIC for ceftriaxone (40.87 to 86.14 mg/L, P < 0.01) among BI isolates. The BI strain remained resistant to fluoroquinolones, but an overall decrease in fluoroquinolone use and increase in cephalosporin use were associated with a decrease in the prevalence of BI, an increased diversity of C. difficile strain types, and the emergence of strains DH and Y.
摘要：
与10年前我们医院的流行病学相反，当时流行限制性核酸内切酶分析（REA）组菌株BI占从首发艰难梭菌感染（CDI）病例中恢复的艰难梭菌分离株的72％，2013-2015年，BI占首发CDI分离株的19%。另外两个REA组菌株占分离株的31%(Y，16%；DH，12%）。BI分离株对氟喹诺酮类和阿奇霉素的高度耐药比DH更常见，Y,和非BI/DH/Y分离株。多变量分析显示，与非BI病例相比，BI病例与氟喹诺酮暴露相关的可能性高2.47倍（95％置信区间[CI]：1.12-5.46）。此外,在第3代或第4代头孢菌素暴露后,DH病例发生CDI的几率是非DH病例的2.83倍(95%CI:1.06~7.54).从2005年到2015年，该医院的氟喹诺酮类药物使用量从113个峰值下降到56个抗菌天数/1,000个患者天数的低点。相比之下,头孢菌素的使用从42天增加到81天抗菌药物/1,000天。这些变化与环丙沙星的几何平均MIC降低（61.03至42.65mg/L，P=0.02）和头孢曲松的几何平均MIC增加（40.87至86.14mg/L，BI分离株之间P<0.01)。BI菌株仍然对氟喹诺酮类药物具有抗性，但氟喹诺酮使用的总体减少和头孢菌素使用的增加与BI患病率的下降有关，艰难梭菌菌株类型的多样性增加，以及菌株DH和Y的出现。
