Utilization of Health Services Among Adults With Recurrent Clostridium difficile Infection: A 12-Year Population-Based Study.
Utilization of Health Services Among Adults With Recurrent Clostridium difficile Infection: A 12-Year Population-Based Study.
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DOI：
10.1017/ice.2016.232
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发表时间：
2017-01
影响因子：
4.5
通讯作者：
Escobar GJ
中科院分区：
文献类型：
--
作者：
Kuntz JL;Baker JM;Kipnis P;Li SX;Liu V;Xie Y;Marcella S;Escobar GJ
已经做出了相当大的努力来制定预防和治疗复发性艰难梭菌感染（rCDI）的策略;然而，rCDI对患者医疗保健利用和结局影响的证据有限。比较患有rCDI、非复发性CDI或无CDI的成人的医疗保健利用率和1年死亡率。我们在2001年9月1日至2013年12月31日期间的成人凯撒基金会健康计划成员中进行了巢式病例对照研究。我们通过阳性实验室检查结果的存在来识别CDI，并将患者分为3组：rCDI患者，定义为初始CDI后14-57天内的CDI;非复发性CDI患者;从未发生过CDI的患者。我们进行了3项匹配比较：（1）rCDI与无CDI;（2）rCDI与非复发性CDI;（3）非复发性CDI与无CDI。我们对患者进行了1年的随访，并在匹配患者的年龄、性别和合并症后，比较了两组之间的医疗保健利用情况。我们发现，与非复发性CDI患者和从未发生过CDI的患者相比，rCDI患者在各种环境中的医疗保健利用率始终较高，1年死亡率风险更高。发生初始CDI的患者通常以过度基础、严重疾病和使用为特征。然而，rCDI患者比未经历rCDI的患者经历更大的疾病不良后果。我们的研究结果进一步支持需要继续强调识别和使用新的方法来预防和治疗rCDI。
Considerable efforts have been dedicated to developing strategies to prevent and treat recurrent Clostridium difficile infection (rCDI); however, evidence of the impact of rCDI on patient healthcare utilization and outcomes is limited. To compare healthcare utilization and 1-year mortality among adults who had rCDI, nonrecurrent CDI, or no CDI. We performed a nested case-control study among adult Kaiser Foundation Health Plan members from September 1, 2001, through December 31, 2013. We identified CDI through the presence of a positive laboratory test result and divided patients into 3 groups: patients with rCDI, defined as CDI in the 14–57 days after initial CDI; patients with nonrecurrent CDI; and patients who never had CDI. We conducted 3 matched comparisons: (1) rCDI vs no CDI; (2) rCDI vs nonrecurrent CDI; (3) nonrecurrent CDI vs no CDI. We followed patients for 1 year and compared healthcare utilization between groups, after matching patients on age, sex, and comorbidity. We found that patients with rCDI consistently have substantially higher levels of healthcare utilization in various settings and greater 1-year mortality risk than both patients who had nonrecurrent CDI and patients who never had CDI. Patients who develop an initial CDI are generally characterized by excess underlying, severe illness and utilization. However, patients with rCDI experience even greater adverse consequences of their disease than patients who do not experience rCDI. Our results further support the need for continued emphasis on identifying and using novel approaches to prevent and treat rCDI.
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影响因子：
4.5
作者：
McDonald, L. Clifford;Coignard, Bruno;Kutty, Preeta K.
通讯作者：
Kutty, Preeta K.
影响因子：
3
作者：
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影响因子：
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作者：
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影响因子：
2.6
作者：
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影响因子：
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作者：
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