Burden of Clostridioides difficile infection (CDI) - a systematic review of the epidemiology of primary and recurrent CDI.
Burden of Clostridioides difficile infection (CDI) - a systematic review of the epidemiology of primary and recurrent CDI.
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DOI：
10.1186/s12879-021-06147-y
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发表时间：
2021-05-19
影响因子：
3.7
通讯作者：
Madin-Warburton M
中科院分区：
文献类型：
--
作者：
Finn E;Andersson FL;Madin-Warburton M
艰难梭菌是一种革兰氏阳性厌氧菌，可引起艰难梭菌感染 (CDI)。它已被认为是医疗保健相关感染的主要原因，并对全球公共卫生构成相当大的威胁。本系统文献综述 (SLR) 总结了有关 CDI 流行病学和临床负担的当前证据。进行 SLR 是为了识别 CDI 和复发性 CDI (rCDI) 流行病学研究，以评估患者和疾病特征、发病率、流行病学发现和危险因素。检索了 Embase、MEDLINE 和 Cochrane 图书馆数据库 2009 年至 2019 年的英文文章。包括的地区包括英国、法国、德国、意大利、西班牙、波兰、美国、加拿大、澳大利亚、日本和中国。在确定的 11,243 项研究中，有 165 项满足选择标准。通过对灰色文献的有针对性的审查，确定了另外 20 项研究。最广泛报道的发现是 CDI 和 rCDI 的发病率和危险因素。在报告每个感兴趣国家的医疗保健相关 (HA-CDI) 和社区相关 CDI (CA-CDI) 发病率的关键研究中，美国每 10,000 个患者日的 HA-CDI 和 CA-CDI 发病率分别为 8.00 和 2.00。据报告，欧洲发病率最高的是波兰（HA-CDI：每 10,000 患者日 6.18 例，CA-CDI：每 10,000 患者日 1.4 例），英国最低，HA-CDI 和 CA-CDI 分别为每 10,000 患者日 1.99 例和每 10,000 患者日 0.56 例。随着时间的推移，发病率没有出现明显的趋势，大多数国家报告发病率稳定，但有些国家报告发病率下降或上升。复发性 CDI 的发生率因地理环境而异。与医疗保健相关疾病相比，社区相关疾病的复发率较低。初始 CDI 和复发性 CDI 共有的独立 CDI 危险因素包括年龄增长、抗生素使用、近期住院治疗和质子泵抑制剂 (PPI) 使用。此外，白细胞计数、住院时间和查尔森合并症指数评分是复发性 CDI 的统计显着风险因素，但这些并未在初始 CDI 最常见的统计显着风险因素中报告。尽管存在相当大的异质性，但有证据表明，即使经过过去十年的巨大努力，复发性和原发性 CDI 的发病率仍然很高。在线版本包含可在 10.1186/s12879-021-06147-y 获取的补充材料。
Clostridioides difficile is a Gram-positive anaerobic bacterium, which causes Clostridioides difficile infection (CDI). It has been recognised as a leading cause of healthcare-associated infections and a considerable threat to public health globally. This systematic literature review (SLR) summarises the current evidence on the epidemiology and clinical burden of CDI. A SLR was conducted to identify CDI and recurrent CDI (rCDI) epidemiology studies, to evaluate patient and disease characteristics, incidence rates, epidemiological findings and risk factors. Embase, MEDLINE and the Cochrane Library databases were searched for English articles from 2009 to 2019. Included territories were the United Kingdom, France, Germany, Italy, Spain, Poland, US, Canada, Australia, Japan and China. Of 11,243 studies identified, 165 fulfilled the selection criteria. An additional 20 studies were identified through targeted review of grey literature. The most widely reported findings were incidence and risk factors for CDI and rCDI. Among key studies reporting both healthcare-associated (HA-CDI) and community-associated CDI (CA-CDI) incidence rates for each country of interest, incidence rates per 10,000 patient days in the US were 8.00 and 2.00 for HA-CDI and CA-CDI, respectively. The highest incidence in Europe was reported in Poland (HA-CDI: 6.18 per 10,000 patient days, CA-CDI: 1.4 per 10,000 patient days), the lowest from the UK, at 1.99 per 10,000 patient days and 0.56 per 10,000 patient days for HA-CDI and CA-CDI, respectively. No clear trend for incidence over time emerged, with most countries reporting stable rates but some either a decrease or increase. Rates of recurrent CDI varied based on geographical setting. The rate of recurrence was lower in community-associated disease compared to healthcare-associated disease. Independent CDI risk factors identified common to both initial CDI and recurrent CDI included increasing age, antibiotic use, recent hospitalisation, and proton pump inhibitor (PPI) use. In addition, leukocyte count, length of hospital stays, and Charlson comorbidity index score featured as statistically significant risk factors for recurrent CDI, but these are not reported among the most common statistically significant risk factors for initial CDI. Despite considerable heterogeneity, evidence suggests substantial incidence of recurrent and primary CDI, even after considerable efforts in the last decade. The online version contains supplementary material available at 10.1186/s12879-021-06147-y.
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