A national survey of the prevalence and impact of Clostridium difficile infection among hospitalized inflammatory bowel disease patients
A national survey of the prevalence and impact of Clostridium difficile infection among hospitalized inflammatory bowel disease patients
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DOI：
10.1111/j.1572-0241.2007.01780.x
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发表时间：
2008-06-01
影响因子：
9.8
通讯作者：
Brant, Steven R.
中科院分区：
文献类型：
--
作者：
Nguyen, Geoffrey C.;Kaplan, Gilaad G.;Brant, Steven R.
背景：我们试图确定全国范围内，以人口为基础的艰难梭菌（C。方法：我们分析了全国住院患者样本的出院记录，并使用国际疾病分类第9次修订版临床修改（ICD-9-CM）代码来识别克罗恩病（CD）和溃疡性结肠炎（UC）病例，以及C. 1998年至2004年之间的艰难梭菌感染C.将IBD患者中艰难梭菌的发病率与非IBD胃肠病患者和所有住院患者进行比较。C.艰难梭菌对住院死亡率和资源利用的影响采用多元回归分析。UC患者中的困难（37.3/1000，95%置信区间[CI] 34.0-40.7/1000）高于CD患者（10.9/1，000，95%CI 9.9-12.0/1，000），非IBD胃肠道（GI）患者（4.8/1，000，95% CI 4.6-5.0/1，000）和普通内科患者（4.5/1，000，95% CI 4.2-4.7/1，000）。C. UC患者中艰难梭菌的发病率在7年内几乎翻了一番（26.6/1000至51.2/1000）。调整混杂因素后，C. UC患者中艰难梭菌感染与较高的死亡率相关（比值比[OR] 3.79，95%CI 2.84-5.06），但与CD患者无关（OR 1.66，95%CI 0.75-3.66）。C.艰难梭菌还分别与CD和UC患者65%和46%的住院时间延长相关，这分别与63%和46%的平均住院费用增加相关。艰难梭菌感染是住院IBD患者中日益严重的公共卫生问题，特别是那些患有UC的患者，并且与较高的死亡率和资源利用相关，这促使需要更好的预防措施和早期检测。
BACKGROUND: We sought to determine nationwide, population-based trends in rates of Clostridium difficile (C. difficile) infection among hospitalized inflammatory bowel disease (IBD) patients in the United States, and to determine its mortality and economic impact.METHODS: We analyzed discharge records from the Nationwide Inpatient Sample, and used the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes to identify Crohn's disease (CD) and ulcerative colitis (UC) cases, and cases of C. difficile infection between 1998 and 2004. Temporal patterns of C. difficile incidence in IBD patients were compared to non-IBD gastroenterology patients and all-hospitalized patients. The impact of C. difficile on in-hospital mortality and resource utilization was quantified using multiple regression analysis.RESULTS: The prevalence of C. difficile among UC patients (37.3 per 1,000, 95% confidence interval [CI] 34.0-40.7 per 1,000) was higher than that among CD patients (10.9 per 1,000, 95% CI 9.9-12.0 per 1,000), non-IBD gastrointestinal (GI) patients (4.8 per 1,000, 95% CI 4.6-5.0 per 1,000), and general medical patients (4.5 per 1,000, 95% CI 4.2-4.7 per 1,000). C. difficile incidence nearly doubled among UC patients (26.6 per 1,000 to 51.2 per 1,000) over 7 yr. After adjustment for confounders, C. difficile infection was associated with greater mortality among patients with UC (odds ratio [OR] 3.79, 95% CI 2.84-5.06), but not CD (OR 1.66, 95% CI 0.75-3.66). C. difficile was also associated with 65% and 46% longer lengths of stay, which correlated with 63% and 46% higher average hospital charges, for CD and UC patients, respectively.CONCLUSIONS: C. difficile infection is a growing public health issue among hospitalized IBD patients, especially those with UC, and is associated with higher mortality and resource utilization, prompting the need for better preventative measures and early detection.