Epidemiology and Outcomes of Clostridium difficile Infections in Hematopoietic Stem Cell Transplant Recipients
Epidemiology and Outcomes of Clostridium difficile Infections in Hematopoietic Stem Cell Transplant Recipients
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DOI：
10.1093/cid/cir1035
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发表时间：
2012-04-15
影响因子：
11.8
通讯作者：
Marr, Kieren A.
中科院分区：
文献类型：
--
作者：
Alonso, Carolyn D.;Treadway, Suzanne B.;Marr, Kieren A.
背景资料。艰难梭菌是住院患者感染性腹泻的主要原因，也是接受造血干细胞移植(HSCT)患者的主要担忧。艰难梭菌感染(CDI)的危险因素和自然病史在该人群中知之甚少。我们对2003年1月至2008年12月在我中心接受造血干细胞移植的成年患者进行了一项回顾性嵌套病例对照研究，以描述CDI的流行病学、发生时间和危险因素。在接受造血干细胞移植的患者中，CDI的1年总发生率为9.2%(n=999)。自体和异基因HSCT受者诊断CDI的中位时间均较短(分别为6.5天和33天)。异基因造血干细胞移植受者发生CDI的危险因素包括移植前接受化疗、广谱抗菌药物的使用和急性移植物抗宿主病(GVHD；调整后的优势比[AOR]，4.45；95%可信区间[CI]，1.54-12.84；P=.006)。在异基因造血干细胞移植后的一年内，早期CDI和随后的胃肠道移植物抗宿主病的发展有很强的相关性(P<；.001)。胃肠道移植物抗宿主病也与CDI复发的风险增加密切相关(AOR，4.23[95%CI，1.20-14.86]；P=0.02)。这些结果突出了HSCT后CDI的高发生率和早期发生的时机。早期的时机，再加上移植前化疗的风险，表明一些患者的自然病史可能涉及移植前的定植。观察到CDI和GVHD之间涉及胃肠道的潜在的重要相互作用。
Background. Clostridium difficile is the leading cause of infectious diarrhea among hospitalized patients and is a major concern for patients undergoing hematopoietic stem cell transplantation (HSCT). Risk factors and the natural history of C. difficile infection (CDI) are poorly understood in this population.Methods. We performed a retrospective nested case-control study to describe the epidemiology, timing, and risk factors for CDI among adult patients who received HSCTs at our center from January 2003 through December 2008.Results. The overall 1-year incidence of CDI was 9.2% among HSCTs performed (n = 999). The median time to diagnosis of CDI was short among both autologous and allogeneic HSCT recipients (6.5 days and 33 days, respectively). Risk factors for CDI in allogeneic HSCT recipients included receipt of chemotherapy prior to conditioning for HSCT, broad-spectrum antimicrobial use, and acute graft-versus-host disease (GVHD; adjusted odds ratio [AOR], 4.45; 95% confidence interval [CI], 1.54-12.84; P = .006). There was a strong relationship between early CDI and subsequent development of gastrointestinal tract GVHD in the year following allogeneic HSCT (P < .001). Gastrointestinal GVHD was also strongly associated with an increased risk for recurrent CDI (AOR, 4.23 [95% CI, 1.20-14.86]; P = .02).Conclusions. These results highlight the high incidence and early timing of CDI after HSCT. Early timing, coupled with the noted risk of pretransplant chemotherapy, suggests that the natural history of disease in some patients may involve colonization prior to HSCT. A potentially important interplay between CDI and GVHD involving the gastrointestinal tract was observed.