Hintergrund: Clostridium difficile ist
ein zunehmend wichtiger Erreger Krankenhaus-erworbener Infektionen
mit der pseudomembranösen Colitis als wesentlicher Erkrankung.
Die Modalitäten der Transmission und auch der Epidemiologie
des Erregers sind noch nicht vollständig geklärt.
Patienten und Methodik: Stuhlproben von 1164 Patienten (571
Frauen und 593 Männer) wurden hinsichtlich des Auftretens
von C. difficile untersucht.
Verlaufsuntersuchungen und die molekularbiologische Typisierung
der Isolate wurden zur Klärung von etwaigen Infektionsketten
und nosokomialen Transmissionen durchgeführt. Zusätzlich
wurden Umfelduntersuchungen vorgenommen.
Ergebnisse: Die Inzidenz der C. difficile -Infektion
im Untersuchungsgut betrug 8,4 %. Nahezu alle
Patienten (92,9 %) waren mit Antibiotika vorbehandelt,
mittels molekulargenetischer Methoden lässt sich eine nosokomiale
Erregertransmission wahrscheinlich machen. Umfelduntersuchungen
zeigen ein geringes Maß an kontaminierten Materialien,
jedoch waren Toilettenstühle zu 15,4 % kontaminiert
und stellen damit ein Risiko für nosokomiale Infektionen
dar. Personaluntersuchungen erbrachten lediglich einen positiven
Nachweis.
Folgerung: C. difficile
ist ein Hospitalkeim, der erhebliche
Ansprüche an das Patienten- und Hygienemanagement in der
Klinik stellt.
Nosocomial epidemiology and transmission
of Clostridium difficile infection
Background: Clostridium difficile
is of growing importance as
a hospital-acquired pathogen. Pseudomembraneous colitis is the main
clinical disease. Transmission and epidemiological features are
not yet fully understood.
Patients and methods: Stool samples from 1164 individuals (571
women and 593 men) attending were examined for the presence of C.
difficile. Follow-up examinations and molecular typing methods were
used for the detection nosocomial transmissions. Additionally, hospital-borne
environmental samples as well as staff samples were tested.
Results: Incidence of C. difficile infection
was 8,4 %. Nearly all patients (92,9 %)
had antibiotics given. Using molecular typing nosocomial transmission
was evident. Though, envrionmental samples in general had a low
positivity, toilet chairs were contaminated in 15.4 % and
may be a potential source of transmission. Staff was positive in
only one case.
Conclusions: Prevention of infections
with C. difficile becomes to be a maior threat for the clinical
and hygienic management.
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Korrespondenz
Prof. Dr. Bernhard R. Ruf
2. Klinik für Innere Medizin Klinikum
St. Georg Leipzig
Delitzscher Straße 141
04129 Leipzig
Telefon: +49/341/9092601
Fax: +49/341/9092630
eMail: ruf@sanktgeorg.de