Outcomes in children with Clostridium difficile infection: results from a nationwide survey
Outcomes in children with Clostridium difficile infection: results from a nationwide survey
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DOI：
10.1093/gastro/gow007
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发表时间：
2016-11-01
影响因子：
3.6
通讯作者：
Khanna, Sahil
中科院分区：
文献类型：
--
作者：
Gupta, Arjun;Pardi, Darrell S.;Khanna, Sahil
目标：基于医院和人群的研究表明，成人和儿童艰难梭菌感染（CDI）的发病率不断增加;尽管儿科CDI结局尚不完全清楚。我们分析了美国国家医院出院调查（NHDS）的数据，研究CDI在住院children.Methods：NHDS数据为2005-2009年（人口统计学，诊断和出院状态），病例和合并症，确定使用ICD-9代码。进行了加权单变量和多变量分析，以确定CDI的发生率; CDI和结果[住院时间（LOS），结肠切除术，全因住院死亡率和出院到护理机构（DTCF）]之间的关联。结果：在估计的1380万儿科住院患者中，46176例有CDI;中位年龄为3岁;总发病率为33.5/10000住院。CDI的年频率在2005年至2009年之间没有变化（0.24-0.43%; P = 0.64）。在单变量分析中，CDI儿童的中位LOS较长（6 vs 2天），结肠切除率较高[比值比（OR）2.0; 95%置信区间（CI）1.7-2.4]，死亡率（OR 2.5; 95% CI 2.3-2.7）和DTCF（OR 1.6; 95% CI 1.6-1.7）（均P < 0.0001）。校正年龄、性别和合并症后，CDI是LOS增加的独立和最强预测因子（调整后的平均差异，6.4天; 95% CI 5.4-7.4），结肠切除术率较高（OR 2.1; 95%CI 1.8-2.5）、死亡率（OR 2.3; 95%CI 2.2-2.5）和DTCF（OR 1.7; 95%CI 1.6-1.8）（所有P < 0.0001）。在排除婴儿的分析，儿童CDI有较高的死亡率，DTCF和较长的LOS比儿童没有CDI.Conclusions：尽管提高认识和管理的进步，CDI仍然是一个重大问题，并与增加LOS，结肠切除术，住院儿童的住院死亡率和DTCF。
Objective: Hospital-and population-based studies demonstrate an increasing incidence of Clostridium difficile infection (CDI) in adults and children; although pediatric CDI outcomes are incompletely understood. We analysed United States National Hospital Discharge Survey (NHDS) data to study CDI in hospitalized children.Methods: NHDS data for 2005-2009 (demographics, diagnoses and discharge status) were obtained; cases and comorbidities were identified using ICD-9 codes. Weighted univariate and multivariate analyses were performed to ascertain incidence of CDI; associations between CDI and outcomes [length of stay (LOS), colectomy, all-cause in-hospital mortality and discharge to a care facility (DTCF)].Results: Of an estimated 13.8 million pediatric inpatients; 46 176 had CDI; median age was 3 years; overall incidence was 33.5/10 000 hospitalizations. The annual frequency of CDI did not vary from 2005 to 2009 (0.24-0.43%; P = 0.64). On univariate analyses, children with CDI had a longer median LOS (6 vs 2 days), higher rates of colectomy [odds ratio (OR) 2.0; 95% confidence interval (CI) 1.7-2.4], mortality (OR 2.5; 95% CI 2.3-2.7), and DTCF (OR 1.6; 95% CI 1.6-1.7) (all P < 0.0001). After adjusting for age, sex and comorbidities, CDI was an independent and the strongest predictor of increased LOS (adjusted mean difference, 6.4 days; 95% CI 5.4-7.4), higher rates of colectomy (OR 2.1; 95% CI 1.8-2.5), mortality (OR 2.3; 95% CI 2.2-2.5), and DTCF (OR 1.7; 95% CI 1.6-1.8) (all P < 0.0001). On excluding infants from the analysis, children with CDI had higher rates of mortality, DTCF and longer LOS than children without CDI.Conclusions: Despite increased awareness and advancements in management, CDI remains a significant problem and is associated with increased LOS, colectomy, in-hospital mortality and DTCF in hospitalized children.