Clostridium difficile-associated disease in a setting of endemicity:: Identification of novel risk factors
Clostridium difficile-associated disease in a setting of endemicity:: Identification of novel risk factors
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DOI：
10.1086/523582
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发表时间：
2007-12-15
影响因子：
11.8
通讯作者：
Fraser, Victoria J.
中科院分区：
文献类型：
--
作者：
Dubberke, Erik R.;Reske, Kimberly A.;Fraser, Victoria J.
背景资料。以前对艰难梭菌相关性疾病(CDAD)危险因素的研究受到样本量小和病例对照研究设计的限制。其中许多研究是在CDAD暴发期间进行的。定植压力和氟喹诺酮类药物、万古霉素和胃酸抑制药的使用尚未被完全评估为CDAD的危险因素。本研究的目的是确定地方性CDAD的危险因素，包括CDAD压力，一种改良的殖民压力。我们对2003年1月1日至2003年12月31日期间在巴恩斯-犹太医院(密苏里州圣路易斯)住院的36,086名患者进行了一项回顾性队列研究。管理、实验室和药房数据从电子医院数据库中收集。定植压力是通过替代变量(即CDAD压力)测量的。采用多因素混合Logistic回归模型对CDAD的独立危险因素进行评估。分析包括382例CDAD患者入院和35,704例非病例患者入院。CDAD的显著独立危险因素包括年龄增加、入院60天(S)、低蛋白血症、白血病和/或淋巴瘤、机械通气、接受抗动力药物、组胺-2阻滞剂、质子泵抑制剂、静脉注射万古霉素、氟喹诺酮类药物和第一代、第三代或第四代头孢菌素。CDAD压力增加是CDAD的强烈危险因素(对于CDAD压力1.4，优势比为4.0；95%可信区间为2.9-5.6)。接受甲硝唑治疗对CDAD有保护作用(优势比为0.5；95%可信区间为0.3-0.6)。本研究确定了先前未被认识到的CDAD压力和万古霉素的CDAD危险因素。需要更多的研究来评估CDAD、这些危险因素与胃酸抑制剂和氟喹诺酮类药物的使用之间的关系。
Background. Previous studies of risk factors for Clostridium difficile-associated disease (CDAD) have been limited by small sample sizes and case-control study designs. Many of these studies were performed during outbreaks of CDAD. Colonization pressure and use of fluoroquinolones, vancomycin, and gastric acid suppressors have not been fully evaluated as risk factors for CDAD. The purpose of this study was to determine risk factors for endemic CDAD, including CDAD pressure, a modified version of colonization pressure.Methods. We performed a retrospective cohort study of 36,086 patients admitted to Barnes-Jewish Hospital (St. Louis, MO) during the period from 1 January 2003 through 31 December 2003. Administrative, laboratory, and pharmacy data were collected from electronic hospital databases. Colonization pressure was measured through a surrogate variable (i.e., CDAD pressure). Multivariable pooled logistic regression models were used to evaluate independent risk factors for CDAD.Results. The analysis included 382 CDAD case patient admissions and 35,704 non-case patient admissions. Significant independent risk factors for CDAD included increasing age, admission(s) in the previous 60 days, hypoalbuminemia, leukemia and/or lymphoma, mechanical ventilation, and receipt of antimotility drugs, histamine-2 blockers, proton pump inhibitors, intravenous vancomycin, fluoroquinolones, and first-, third-, or fourth-generation cephalosporins. Increasing CDAD pressure was a strong risk factor for CDAD (for a CDAD pressure > 1.4, the odds ratio was 4.0; 95% confidence interval, 2.9-5.6). Receipt of metronidazole was protective against CDAD (odds ratio, 0.5; 95% confidence interval, 0.3-0.6).Conclusions. This study identified the previously underrecognized CDAD risk factors of CDAD pressure and vancomycin. More studies are needed to evaluate the relationship between CDAD, these risk factors, and use of gastric acid suppressors and fluoroquinolones.