Trends in U.S. Burden of Clostridioides difficile Infection and Outcomes.
Trends in U.S. Burden of Clostridioides difficile Infection and Outcomes.
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美国梭菌艰难梭菌感染和结果负担的趋势。
DOI：
10.1056/nejmoa1910215
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发表时间：
2020-04-02
期刊：
影响因子：
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通讯作者：
Emerging Infections Program Clostridioides difficile Infection Working Group
中科院分区：
文献类型：
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作者：
Guh AY;Mu Y;Winston LG;Johnston H;Olson D;Farley MM;Wilson LE;Holzbauer SM;Phipps EC;Dumyati GK;Beldavs ZG;Kainer MA;Karlsson M;Gerding DN;McDonald LC;Emerging Infections Program Clostridioides difficile Infection Working Group
在美国，预防艰难梭菌感染的努力继续扩大到整个医疗保健领域。这些努力是否正在减轻艰难梭菌感染的国家负担尚不清楚。 The Emerging Infections Program identified cases of C. difficile infection (stool specimens positive for C. difficile in a person ≥1 year of age with no positive test in the previous 8 weeks) in 10 U.S. sites.我们使用病例和人口普查抽样权重来估计 2011 年至 2017 年艰难梭菌感染、首次复发、住院治疗和院内死亡的全国负担。医疗保健相关感染被定义为在医疗保健机构中发病或与最近入住医疗保健机构相关的感染； all others were classified as community-associated infections.对于趋势分析，我们使用负二项分布的加权随机截距模型和逻辑回归模型来调整核酸扩增测试 (NAAT) 与其他测试类型相比的更高灵敏度。 2011 年，美国 10 个地点的艰难梭菌感染病例数为 15,461 例（10,177 例医疗保健相关病例和 5284 例社区相关病例），2017 年为 15,512 例（7973 例医疗保健相关病例和 7539 例社区相关病例）。 2011 年全国艰难梭菌感染估计负担为 476,400 例（95% 置信区间 [CI]，419,900 至 532,900），2017 年为 462,100 例（95% CI，428,600 至 495,600）。考虑到 NAAT 的使用，调整后的艰难梭菌总负担估计值感染率下降 24%（95% CI，6 至 36) 从 2011 年到 2017 年；医疗保健相关艰难梭菌感染的国家负担的调整后估计下降了 36%（95% CI，24 至 54），而社区相关艰难梭菌感染的国家负担的调整后估计没有变化。艰难梭菌感染住院负担的调整后估计下降了 24%（95% CI，0 至 48），而首次复发和院内死亡负担的调整后估计没有显着变化。由于医疗保健相关感染的减少，从 2011 年到 2017 年，全国艰难梭菌感染和相关住院治疗的估计负担有所下降。 （由疾病控制和预防中心资助。）
Efforts to prevent Clostridioides difficile infection continue to expand across the health care spectrum in the United States. Whether these efforts are reducing the national burden of C. difficile infection is unclear. The Emerging Infections Program identified cases of C. difficile infection (stool specimens positive for C. difficile in a person ≥1 year of age with no positive test in the previous 8 weeks) in 10 U.S. sites. We used case and census sampling weights to estimate the national burden of C. difficile infection, first recurrences, hospitalizations, and in-hospital deaths from 2011 through 2017. Health care–associated infections were defined as those with onset in a health care facility or associated with recent admission to a health care facility; all others were classified as community-associated infections. For trend analyses, we used weighted random-intercept models with negative binomial distribution and logistic-regression models to adjust for the higher sensitivity of nucleic acid amplification tests (NAATs) as compared with other test types. The number of cases of C. difficile infection in the 10 U.S. sites was 15,461 in 2011 (10,177 health care–associated and 5284 community-associated cases) and 15,512 in 2017 (7973 health care–associated and 7539 community-associated cases). The estimated national burden of C. difficile infection was 476,400 cases (95% confidence interval [CI], 419,900 to 532,900) in 2011 and 462,100 cases (95% CI, 428,600 to 495,600) in 2017. With accounting for NAAT use, the adjusted estimate of the total burden of C. difficile infection decreased by 24% (95% CI, 6 to 36) from 2011 through 2017; the adjusted estimate of the national burden of health care–associated C. difficile infection decreased by 36% (95% CI, 24 to 54), whereas the adjusted estimate of the national burden of community-associated C. difficile infection was unchanged. The adjusted estimate of the burden of hospitalizations for C. difficile infection decreased by 24% (95% CI, 0 to 48), whereas the adjusted estimates of the burden of first recurrences and in-hospital deaths did not change significantly. The estimated national burden of C. difficile infection and associated hospitalizations decreased from 2011 through 2017, owing to a decline in health care–associated infections. (Funded by the Centers for Disease Control and Prevention.)