Mortality Following Clostridioides difficile Infection in Europe: A Retrospective Multicenter Case-Control Study.
Mortality Following Clostridioides difficile Infection in Europe: A Retrospective Multicenter Case-Control Study.
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欧洲艰难梭菌感染后的死亡率：一项回顾性多中心病例对照研究。
DOI：
10.3390/antibiotics10030299
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发表时间：
2021-03-13
期刊：
影响因子：
--
通讯作者：
Garlicki A
中科院分区：
文献类型：
--
作者：
Czepiel J;Krutova M;Mizrahi A;Khanafer N;Enoch DA;Patyi M;Deptuła A;Agodi A;Nuvials X;Pituch H;Wójcik-Bugajska M;Filipczak-Bryniarska I;Brzozowski B;Krzanowski M;Konturek K;Fedewicz M;Michalak M;Monpierre L;Vanhems P;Gouliouris T;Jurczyszyn A;Goldman-Mazur S;Wultańska D;Kuijper EJ;Skupień J;Biesiada G;Garlicki A
我们的目的是描述艰难梭菌感染（CDI）的临床表现、治疗、结果和报告与90天内死亡率相关的因素。描述性、单变量和多变量回归分析对来自七个欧洲国家的九家医院进行的回顾性病例对照研究中收集的数据进行了分析。共纳入624例患者，其中415例死亡（病例），209例在CDI诊断后90天仍存活（对照组）。两组患者以前最常用的抗生素是β-内酰胺类抗生素；死亡患者以前接触氟喹诺酮类药物的人数显著增加（p = 0.0004）。多因素logistic回归显示，与CDI期间死亡独立相关的因素有：年龄较大、CDI治疗不充分、恶病质、恶性肿瘤、Charlson指数、长期护理、白细胞计数（WBC）升高、c反应蛋白（CRP）、菌血症、并发症和认知障碍。此外，年龄较大、白细胞、中性粒细胞、CRP或肌酐水平较高、存在恶性肿瘤、认知障碍和并发症与缩短CDI诊断至死亡的时间密切相关。CDI的预防应主要集中在接受抗生素治疗的住院老年人。对于每一位接受CDI治疗的住院患者，应检测白细胞、中性粒细胞计数、CRP、肌酐、白蛋白和乳酸水平，以评估致命结局的风险。
We aimed to describe the clinical presentation, treatment, outcome and report on factors associated with mortality over a 90-day period in Clostridioides difficile infection (CDI). Descriptive, univariate, and multivariate regression analyses were performed on data collected in a retrospective case-control study conducted in nine hospitals from seven European countries. A total of 624 patients were included, of which 415 were deceased (cases) and 209 were still alive 90 days after a CDI diagnosis (controls). The most common antibiotics used previously in both groups were β-lactams; previous exposure to fluoroquinolones was significantly (p = 0.0004) greater in deceased patients. Multivariate logistic regression showed that the factors independently related with death during CDI were older age, inadequate CDI therapy, cachexia, malignancy, Charlson Index, long-term care, elevated white blood cell count (WBC), C-reactive protein (CRP), bacteraemia, complications, and cognitive impairment. In addition, older age, higher levels of WBC, neutrophil, CRP or creatinine, the presence of malignancy, cognitive impairment, and complications were strongly correlated with shortening the time from CDI diagnosis to death. CDI prevention should be primarily focused on hospitalised elderly people receiving antibiotics. WBC, neutrophil count, CRP, creatinine, albumin and lactate levels should be tested in every hospitalised patient treated for CDI to assess the risk of a fatal outcome.
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