Healthcare facility-onset, healthcare facility-associated Clostridioides difficile infection in Veterans with spinal cord injury and disorder.
Healthcare facility-onset, healthcare facility-associated Clostridioides difficile infection in Veterans with spinal cord injury and disorder.
复制标题
患有脊髓损伤和疾病的退伍军人中医疗机构发病、医疗机构相关的艰难梭菌感染。
DOI：
10.1080/10790268.2019.1672953
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
Johnson,Stuart
中科院分区：
文献类型：
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作者：
Evans,CharlesnikaT;Fitzpatrick,Margaret;Ramanathan,Swetha;Kralovic,StephenM;Burns,StephenP;Goldstein,Barry;Smith,Bridget;Gerding,DaleN;Johnson,Stuart
目的：描述患有脊髓损伤和疾病 (SCI/D) 的退伍军人中医疗机构发病的医疗机构相关 (HO-HCFA) 艰难梭菌感染 (CDI) 的负担和风险。设计：2001 年 10 月 1 日至 2010 年 9 月 30 日的回顾性纵向队列研究。地点：94 个急性护理退伍军人事务机构。参与者：患者SCI/D. 结果：HO-HCFA CDI 的发生率。方法：确定 CDI 的发生率，并计算粗未调整的发生率比 (IRR) 和 95% 置信区间 (CI)。采用多变量泊松随机效应回归分析来评估与CDI发生率独立相关的因素。结果：共鉴定出1,409例HO-HCFA CDI。 2002 年的 CDI 率为 13.9/10,000 人日，到 2010 年下降至 5.5/10,000 人日。多变量回归分析发现，抗生素（IRR = 18.79，95% CI 14.09-25.07）和质子泵抑制剂（PPI）或 H2 阻滞剂的使用(IRR = 7.71, 95% CI 5.47-10.86) 均与 HO-HCFA CDI 独立相关。暴露于两种药物显示出协同风险（IRR = 37.55，95% CI 28.39-49.67）。年龄较大、东北地区和前 30 天的侵入性呼吸手术也是独立的危险因素，而较长的 SCI 持续时间和在 SCI 中心的护理具有保护作用。结论：虽然 SCI/D 患者的 CDI 发生率有所下降，但其发生率仍然很高。减少抗生素和 PPI/H2 阻滞剂使用的有针对性的抗菌药物管理和药房干预措施可能对降低这一高危人群的 HO-HCFA CDI 产生深远的益处。
Objective:To describe the burden and risk of healthcare facility-onset, healthcare facility-associated (HO-HCFA)Clostridioides difficileinfection (CDI) in Veterans with spinal cord injury and disorder (SCI/D).Design:Retrospective, longitudinal cohort study from October 1, 2001–September 30, 2010.Setting:Ninety-four acute care Veterans Affairs facilities.Participants:Patients with SCI/D.Outcomes:Incidence rate of HO-HCFA CDI.Methods:Rates of CDI were determined, and crude unadjusted incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were calculated. Multivariable Poisson random-effects regression analyses were used to assess factors independently associated with the rate of CDI.Results:1,409 cases of HO-HCFA CDI were identified. CDI rates in 2002 were 13.9/10,000 person-days and decreased to 5.5/10,000 person-days by 2010. Multivariable regression analyses found that antibiotic (IRR = 18.79, 95% CI 14.09-25.07) and proton-pump inhibitor (PPI) or H2 blocker use (IRR = 7.71, 95% CI 5.47-10.86) were both independently associated with HO-HCFA CDI. Exposure to both medications demonstrated a synergistic risk (IRR = 37.55, 95% CI 28.39-49.67). Older age, Northeast region, and invasive respiratory procedure in the prior 30 days were also independent risk factors, while longer SCI duration and care at a SCI center were protective.Conclusion:Although decreasing, CDI rates in patients with SCI/D remain high. Targeted antimicrobial stewardship and pharmacy interventions that reduce antibiotic and PPI/H2 blocker use could have profound benefits in decreasing HO-HCFA CDI in this high-risk population.