Time interval of increased risk for Clostridium difficile infection after exposure to antibiotics
Time interval of increased risk for Clostridium difficile infection after exposure to antibiotics
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DOI：
10.1093/jac/dkr508
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发表时间：
2012-03-01
影响因子：
5.2
通讯作者：
Kuijper, Ed J.
中科院分区：
文献类型：
--
作者：
Hensgens, Marjolein P. M.;Goorhuis, Abraham;Kuijper, Ed J.
艰难梭菌感染(CDI)在发达国家很常见，在美国每年影响250000住院患者。该病最重要的危险因素是抗生素治疗。为了确定停用抗生素后CDI的风险时间，我们于2006年3月至2009年5月在荷兰进行了一项多中心病例对照研究。对337例腹泻住院患者和337例非腹泻患者进行了比较。此外，纳入了CDI以外原因引起的腹泻患者的对照组(N227)。在纳入日期的前一个月，CDI患者使用抗生素的频率高于非腹泻患者(77比49)。在抗生素治疗期间和停止治疗后的第一个月，患者发生CDI的风险增加了710倍(OR 6.710.4)。在停用抗生素后的1至3个月期间，这一风险下降(OR 2.7)。当使用第二个对照组时，也观察到了类似的结果。除第一代头孢菌素和大环内酯类外，所有抗生素类均与CDI有关。第二代和第三代头孢菌素类(OR3.3和5.3)和碳青霉烯类(OR4.7)是CDI的最强危险因素。与非腹泻患者相比，CDI患者使用了更多的抗生素类别和更明确的日剂量。在治疗期间和停止抗生素治疗后的3个月内，抗菌药物的使用增加了CDI的风险。CDI的风险最高的是在抗生素使用期间和之后的第一个月。我们的研究将有助于临床医生识别高危患者。
Clostridium difficile infections (CDIs) are common in developed countries and affect 250000 hospitalized patients annually in the USA. The most important risk factor for the disease is antibiotic therapy.To determine the period at risk for CDI after cessation of antibiotics, we performed a multicentre casecontrol study in the Netherlands between March 2006 and May 2009. Three hundred and thirty-seven hospitalized patients with diarrhoea and a positive toxin test were compared with 337 patients without diarrhoea. Additionally, a control group of patients with diarrhoea due to a cause other than CDI (n227) was included.In the month prior to the date of inclusion, CDI patients more frequently used an antibiotic compared with non-diarrhoeal patients (77 versus 49). During antibiotic therapy and in the first month after cessation of the therapy, patients had a 710-fold increased risk for CDI (OR 6.710.4). This risk declined in the period between 1 and 3 months after the antibiotic was stopped (OR 2.7). Similar results were observed when the second control group was used. All antibiotic classes, except first-generation cephalosporins and macrolides, were associated with CDI. Second- and third-generation cephalosporins (OR 3.3 and 5.3, respectively) and carbapenems (OR 4.7) were the strongest risk factors for CDI. Patients with CDI used more antibiotic classes and more defined daily doses, compared with non-diarrhoeal patients.Antibiotic use increases the risk for CDI during therapy and in the period of 3 months after cessation of antibiotic therapy. The highest risk for CDI was found during and in the first month after antibiotic use. Our study will aid clinicians to identify high-risk patients.