Risk Factors and Outcomes for Bloodstream Infections Secondary to Clostridium difficile Infection
Risk Factors and Outcomes for Bloodstream Infections Secondary to Clostridium difficile Infection
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DOI：
10.1128/aac.01927-15
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发表时间：
2016-01-01
影响因子：
4.9
通讯作者：
Venditti, Mario
中科院分区：
文献类型：
--
作者：
Falcone, Marco;Russo, Alessandro;Venditti, Mario
我们确定了艰难梭菌感染（CDI）后血流感染（BSI）的发生率、危险因素和结局。我们对2014年1月至2014年12月在罗马两家大型医院住院的确诊为CDI的所有患者进行了回顾性研究。分析了两组患者：CDI和随后的BSI（CDI/BSI+）和CDI和无原发性BSI证据（CDI/BSI+）。获得了有关临床特征、微生物学、治疗和死亡率的数据。总体而言，最终分析中纳入了393例CDI病例：72例发生了原发性院内BSI，而321例发生了无BSI微生物学和临床证据的CDI。BSI的病原体为念珠菌属（47.3%）、肠杆菌科（19.4%）、肠球菌属（13.9%）和混合感染（19.4%）。在多变量分析中，核糖体027状态（比值比[OR]，6.5）、CDI复发（OR，5.5）、严重CDI感染（OR，8.3）和口服万古霉素>500 mg/天（OR，3.1）被认为是与医院内BSI发展独立相关的因素。CDI/BSI+组患者的CDI诊断后30天死亡率高于对照组（38.9% vs 13.1%; P < 0.001）。在CDI/BSI+组患者中，原发性BSI导致的死亡率高达57%。我们的研究结果表明，严重的CDI是复杂的医院BSI的发展。念珠菌属和肠道细菌似乎是主要的致病病原体，并且与不良结果相关。
We determined the incidence, risk factors, and outcomes of bloodstream infections (BSI) subsequent to Clostridium difficile infection (CDI). We performed a retrospective study of all patients with definite diagnosis of CDI admitted from January 2014 to December 2014 in two large hospitals in Rome. Two groups of patients were analyzed: those with CDI and subsequent BSI (CDI/BSI+) and those with CDI and no evidence of primary BSI (CDI/BSI+). Data about clinical features, microbiology, treatments, and mortality were obtained. Overall, 393 cases of CDI were included in the final analysis: 72 developed a primary nosocomial BSI, while 321 had CDI without microbiological and clinical evidence of BSI. Etiologic agents of BSI were Candida species (47.3%), Enterobacteriaceae (19.4%), enterococci (13.9%), and mixed infections (19.4%). In multivariate analysis, ribotype 027 status (odds ratio [OR], 6.5), CDI recurrence (OR, 5.5), severe CDI infection (OR, 8.3), and oral vancomycin at >500 mg/day (OR, 3.1) were recognized as factors independently associated with the development of nosocomial BSI. Thirty-day mortality from CDI diagnosis was higher for patients of the CDI/BSI+ group than for the controls (38.9 versus 13.1%; P < 0.001). Among patients of the CDI/BSI+ group, mortality attributable to primary BSI was as high as 57%. Our findings suggest that severe CDI is complicated by the development of nosocomial BSI. Candida species and enteric bacteria appear to be the leading causative pathogens and are associated with poor outcomes.