Clostridioides difficile infection in immunocompromised hospitalized patients is associated with a high recurrence rate
Clostridioides difficile infection in immunocompromised hospitalized patients is associated with a high recurrence rate
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DOI：
10.1016/j.ijid.2019.10.028
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发表时间：
2020-01-01
影响因子：
8.4
通讯作者：
Bishara, Jihad
中科院分区：
文献类型：
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作者：
Avni, Tomer;Babitch, Tanya;Bishara, Jihad
目的：艰难梭状芽胞杆菌感染(CDI)对免疫功能低下患者(IMC)构成严重威胁。在此，我们评估了合并CDI的IMC患者的临床转归。方法：本研究纳入2013年1月1日至2018年12月31日连续住院的经实验室证实的CDI患者。受试者分为两组：IMC患者和对照组。主要结果是首次发生CDI后30天和90天的复发率(RCDI)。次要结果包括30天和90天全因死亡率、住院时间(LOS)和再住院率。多变量分析调整了复发的其他危险因素。还对IMC患者亚组进行了分析(基于IMC条件的类型)。结果：共纳入573例IMC患者，其中IMC患者149例(实体器官移植36例，化疗38例，血液学疾病62例，大剂量强的松治疗13例)，对照组424例。IMC患者更年轻，更独立，并表现出较少的显著并发症。多因素分析显示，IMC患者的RCDI发生率显著高于IMC患者(OR2.7，95%CI 1.6~5)。RCDI还与万古霉素治疗、血液透析和既往住院有关。两组的死亡率、LOS、CDI并发症和再住院率相似。结论：合并CDI的IMC患者发生90天RCDI的风险增加。万古霉素治疗CDI危及IMC患者的复发。进一步的研究应该探索对患有CDI的IMC患者使用替代药物如非达克西星和贝洛昔单抗的其他治疗方法。(C)爱思唯尔有限公司代表国际传染病学会出版的《2019年》。
Objective: Clostridioides difficile infection (CDI) may pose a serious threat to immunocompromised patients (IMC). Herein, we evaluated the clinical outcomes of IMC patients with CDI.Methods: All consecutive hospitalized patients between January 1, 2013 and December 31, 2018 with laboratory confirmed CDI were included in the study. Subjects were divided into two groups: IMC patients and controls. Primary outcome was the recurrence rate of CDI (rCDI) at 30 and 90 days after the first CDI episode. Secondary outcomes included 30 and 90 day all-cause mortality, length of hospital stay (LOS) and readmission rates. A multivariate analysis adjusted other risk factors for recurrence. An analysis of IMC patient subgroups (based on type of IMC conditions) was also performed. Results are reported as odds ratios (OR) with a 95% confidence interval (95% CI).Results: A total of 573 patients were included, amongst them 149 IMC patients (36 solid organ transplants, 38 undergoing chemotherapy, 62 haematological conditions, 13 receiving high dose prednisone) and 424 controls. IMC patients were younger, independent and exhibited less significant comorbidities. On multivariable analysis, the rate of rCDI was significantly higher in IMC patients (OR 2.7, 95% CI 1.6-5). rCDI was also associated with vancomycin therapy, haemodialysis and previous hospitalizations. Mortality, LOS, CDI complications and rehospitalization rates were similar in both.Conclusions: IMC patients with CDI have an increased risk of 90 days rCDI. Vancomycin treatment for CDI endangers recurrence in IMC patients. Further research should explore other therapies for IMC patients with CDI with alternative agents such as Fidaxomicin and Bezlotoxumab. (C) 2019 Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.