Clinical predictors of recurrent Clostridium difficile infection in out-patients
Clinical predictors of recurrent Clostridium difficile infection in out-patients
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DOI：
10.1111/apt.12864
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发表时间：
2014-09-01
影响因子：
7.6
通讯作者：
Pardi, D. S.
中科院分区：
文献类型：
--
作者：
Shivashankar, R.;Khanna, S.;Pardi, D. S.
BackgroundClostridium difficile infection（CDI）recurs in 20- 30%of patients.AimTo describe the predictors of recurrence in outpatients with CDI. MethodsOutpatient cases of CDI in Olmsted County，MN residents diagnosed between 2007年6月28日和2010年6月25日进行了鉴定。复发性CDI定义为C阳性腹泻复发。在初步诊断后15至56天进行艰难梭菌PCR检测，症状暂时缓解。排除14天内两次检测呈阳性的患者。考克斯比例风险模型被用来评估相关的临床变量与时间复发的CDI.ResultsThe队列包括520门诊患者，104复发CDI（累积发病率为17.5%，30天）。单变量分析确定年龄增加和抗生素使用与复发性CDI相关。重度CDI、外周血白细胞计数和血清肌酐变化>1.5倍均无明显变化。在多变量模型中，合并使用抗生素与CDI复发风险相关（HR = 5.4，95% CI 1.6-17.5，P = 0.005），而年龄（每10年增加的HR = 1.1，95% CI 0.9-1.3，P = 0.22）;外周血白细胞计数>15 x 10（9）/L（HR = 1.0，95% CI 0.5-2.1，P = 0.92）;血清肌酐变化大于1.5倍（HR = 0.8，95% CI 0.4-1.5，P = 0.44）并非如此。结论抗生素的使用与户外复发艰难梭菌感染的巨大风险独立相关。患者队列。重要的是避免艰难梭菌感染患者不必要的全身抗生素，持续使用抗生素的患者应密切监测复发感染。
BackgroundClostridium difficile infection (CDI) recurs in 20-30% of patients.AimTo describe the predictors of recurrence in out-patients with CDI.MethodsOut-patient cases of CDI in Olmsted County, MN residents diagnosed between 28 June 2007 and 25 June 2010 were identified. Recurrent CDI was defined as recurrence of diarrhoea with a positive C. difficile PCR test from 15 to 56 days after the initial diagnosis with interim resolution of symptoms. Patients who had two positive tests within 14 days were excluded. Cox proportional hazard models were used to assess the association of clinical variables with time to recurrence of CDI.ResultsThe cohort included 520 out-patients; 104 had recurrent CDI (cumulative incidence of 17.5% by 30 days). Univariate analysis identified increasing age and antibiotic use to be associated with recurrent CDI. Severe CDI, peripheral leucocyte count and change in serum creatinine >1.5-fold were not. In a multiple variable model, concomitant antibiotic use was associated with risk of recurrent CDI (HR = 5.4, 95% CI 1.6-17.5, P = 0.005), while age (HR per 10 year increase = 1.1, 95% CI 0.9-1.3, P = 0.22); peripheral leucocyte count >15 x 10(9)/L (HR = 1.0, 95% CI 0.5-2.1, P = 0.92); and change in serum creatinine greater than 1.5-fold (HR = 0.8, 95% CI 0.4-1.5, P = 0.44) were not.ConclusionsAntibiotic use was independently associated with a dramatic risk of recurrent Clostridium difficile infection in an out-patient cohort. It is important to avoid unnecessary systemic antibiotics in patients with Clostridium difficile infection, and patients with ongoing antibiotic use should be monitored closely for recurrent infection.