Risk Factors for Hospital-acquired Clostridium difficile Infection Among Pediatric Patients With Cancer
Risk Factors for Hospital-acquired Clostridium difficile Infection Among Pediatric Patients With Cancer
复制标题
DOI：
10.1097/mph.0000000000000742
复制
发表时间：
2017-04-01
影响因子：
1.2
通讯作者：
Manabe, Atsushi
中科院分区：
文献类型：
--
作者：
Daida, Atsuro;Yoshihara, Hiroki;Manabe, Atsushi
医院获得性艰难梭菌感染（CDI）可能会导致危及生命的癌症儿童结肠炎，因此确定危险因素很重要。我们描述了原发性和复发性CDI儿童癌症患者的特征，并评估了潜在的危险因素。在189例癌症患者中，分析51例（27%）CDI和94例无CDI的匹配对照。采用多变量logistic回归评估CDI与几个潜在危险因素之间的关系。CDI病例的中位年龄（3.3岁；0.60 ~ 16.2岁）低于对照组（7.7岁；0.4 ~ 20.5岁）。CDI患者在CDI前中性粒细胞减少的中位持续时间（10.0 d; 0.0 - 30.0）比对照组从参考日期计算的持续时间（6.0 d; 0.0 - 29.0）更长。多变量分析显示，年龄越大与风险降低相关（>= 7 vs. 0 ~ 3 y，比值比=0.11；95%可信区间，0.02 ~ 0.54），中性粒细胞减少延长与风险增加相关（比值比=1.11；95%可信区间，1.01 ~ 1.22）。CDI在26%的病例中复发。年龄较小和中性粒细胞减少时间延长是癌症患儿CDI的危险因素。提高对这些危险因素的认识将有助于确定癌症患者预防CDI的机会。
Hospital-acquired Clostridium difficile infection (CDI) may cause life-threatening colitis for children with cancer, making identification of risk factors important. We described characteristics of pediatric cancer patients with primary and recurring CDI, and evaluated potential risk factors. Among 189 cancer patients, 51 cases (27%) of CDI and 94 matched controls of cancer patients without CDI were analyzed. Multivariable logistic regression was used to evaluate the association between CDI and several potential risk factors. Median age of CDI cases was lower (3.3 y; 0.60 to 16.2) than controls (7.7 y; 0.4 to 20.5). Median duration of neutropenia before CDI was longer for CDI cases (10.0 d; 0.0 to 30.0) compared with duration calculated from reference date in controls (6.0 d; 0.0 to 29.0). Multivariable analysis showed that older age was associated with reduced risk (>= 7 vs. 0 to 3 y, odds ratio=0.11; 95% confidence interval, 0.02-0.54), and prolonged neutropenia was associated with increased risk (odds ratio=1.11; 95% confidence interval, 1.01-1.22). CDI recurred in 26% of cases. Younger age and prolonged neutropenia were risk factors for CDI in children with cancer. Increasing awareness to these risk factors will help to identify opportunities for CDI prevention in cancer patients.