Evaluating risk factors for Clostridium difficile infection in adult and pediatric hematopoietic cell transplant recipients.
Evaluating risk factors for Clostridium difficile infection in adult and pediatric hematopoietic cell transplant recipients.
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DOI：
10.1186/s13756-015-0081-4
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发表时间：
2015
影响因子：
5.5
通讯作者：
Pergam SA
中科院分区：
文献类型：
--
作者：
Boyle NM;Magaret A;Stednick Z;Morrison A;Butler-Wu S;Zerr D;Rogers K;Podczervinski S;Cheng A;Wald A;Pergam SA
尽管造血细胞移植（HCT）受者通常暴露于艰难梭菌感染（CDI）的经典风险因素，但很少有研究评估这些高危患者的CDI风险，尤其缺乏儿科HCT受者的数据。我们的目的是确定成人和儿童异基因HCT受者中CDI的发生率和危险因素。CDI被定义为腹泻，C检测呈阳性。通过PCR、细胞毒素测定或双酶免疫测定检测艰难梭菌。我们纳入了2008年至2012年在Fred哈钦森癌症研究中心接受同种异体HCT的所有患者;排除了<1岁或HCT前8周内发生CDI的患者。通过移植医院（“成人”或“儿科”）对患者进行分类，并在HCT后随访100天。在1182例HCT接受者中，17%（33/192）的儿科接受者诊断为CDI，发生率为20/10，000患者-天，11%（107/990）的成人接受者诊断为CDI，发生率为12/10，000。儿童受者在HCT后中位数51天（四分位距[IQR]：5，72）被诊断，成人在16天（IQR = 5，49）被诊断。与2008日历年相比，2012年移植的儿科受者发生CDI的风险增加（风险比[HR] = 3.99，p = 0.02）。清髓性预处理增加了成年受者的CDI风险（HR = 1.81，p =.005）。儿童和成人同种异体受者HCT后发生CDI的风险较高，尤其是清髓性预处理的成人受者。儿童和成人之间CDI发生率的差异可能是由年龄相关的暴露差异引起的;因此，在未来的CDI研究中应考虑单独评价这些组。
Although hematopoietic cell transplant (HCT) recipients are routinely exposed to classic risk factors for Clostridium difficile infection (CDI), few studies have assessed CDI risk in these high-risk patients, and data are especially lacking for pediatric HCT recipients. We aimed to determine incidence and risk factors for CDI in adult and pediatric allogeneic HCT recipients. CDI was defined as having diarrhea that tested positive for C. difficile via PCR, cytotoxin assay, or dual enzyme immunoassays. We included all patients who received an allogeneic HCT from 2008 to 2012 at the Fred Hutchinson Cancer Research Center; those <1 year old or with CDI within 8 weeks pre-HCT were excluded. Patients were categorized by transplanting hospital (“adult” or “pediatric”) and followed for 100 days post-HCT. Of 1182 HCT recipients, CDI was diagnosed in 17 % (33/192) of pediatric recipients for an incidence of 20 per 10,000 patient-days, and 11 % (107/990) of adult recipients for an incidence of 12 per 10,000. Pediatric recipients were diagnosed a median of 51 days (interquartile range [IQR]: 5, 72) after HCT and adults at 16 days (IQR = 5, 49). Compared with calendar year 2008, pediatric recipients transplanted in 2012 were at increased risk for CDI (hazard ratio [HR] = 3.99, p =.02). Myeloablative conditioning increased CDI risk in adult recipients (HR = 1.81, p =.005). Pediatric and adult allogeneic recipients are at high risk of CDI post-HCT, particularly adult recipients of myeloablative conditioning. Differences in CDI incidence between children and adults may have resulted from exposure differences related to age; therefore, separately evaluating these groups should be considered in future CDI studies.