Clostridioides difficile Infection Among Patients Requiring Maintenance Hemodialysis.
Clostridioides difficile Infection Among Patients Requiring Maintenance Hemodialysis.
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DOI：
10.1016/j.xkme.2021.02.005
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发表时间：
2021-05
期刊：
影响因子：
3.9
通讯作者：
D'Agata EMC
中科院分区：
文献类型：
--
作者：
Radhakrishnan P;Vishwanath M;Shemin D;Monteiro JFG;D'Agata EMC
艰难梭菌是美国胃肠炎相关死亡的最常见原因。 1 维持性血液透析 (HD) 人群中艰难梭菌感染 (CDI) 的比例正在增加。 2 与一般人群相比，这些患者患 CDI 的可能性高出 2.5 倍，死亡率高出 2 倍。 3, 4 住院费用和住院时间也更长。 5 需要维持 HD 的患者中，有关 CDI 临床流行病学的数据很少。为了改善该患者群体中 CDI 的管理和结果，我们与非重度 CDI 相比，对与严重或暴发性 CDI 相关的临床因素进行了描述，并确定了死亡风险最高的 CDI 维持性 HD 患者子集。从 2015 年 1 月到 2018 年 12 月，我们对罗德岛州一家拥有 700 个床位和 255 个床位的三级护理医院入院时被诊断为 CDI 的需要维持性 HD 的患者进行了一项回顾性队列研究。获得了道德委员会的批准（#1327710）。由于该研究是回顾性的，因此放弃了知情同意。仅包括每位患者的第一次发作。 CDI 被定义为使用 GeneXpert 检测 (Cepheid) 和腹泻记录的阳性检测结果。美国传染病学会 (IDSA) 标准用于对 CDI 严重程度进行分类。 6 非重度和重度 CDI 分别定义为白细胞 (WBC) 计数≤ 15,000 个细胞/mL 和 WBC 计数≥ 15,000 个细胞/mL。暴发性 CDI 需要存在低血压或休克、巨结肠或肠梗阻。 IDSA 标准还包括血清肌酐值，但这些被排除在研究定义中。
Clostridioides difficile is the most common cause of gastroenteritis-related death in the United States. 1 Rates of C difficile infection (CDI) are increasing in the maintenance hemodialysis (HD) population. 2 These patients are 2.5 times more likely to develop CDI and have 2-fold higher mortality rates compared with the general population. 3, 4 Hospital costs and lengths of stay are also longer. 5 There is a paucity of data pertaining to the clinical epidemiology of CDI among patients requiring maintenance HD. To improve the management and outcomes of CDI in this patient population, we characterized clinical factors associated with severe or fulminant CDI, compared with nonsevere CDI, and identified the subset of maintenance HD patients with CDI at highest risk for mortality.From January 2015 through December 2018, a retrospective cohort study among patients requiring maintenance HD with a diagnosis of CDI at admission to a 700-and 255-bed tertiary-care hospital in Rhode Island was conducted. Approval from the ethics board was obtained (# 1327710). Informed consent was waived because the study was retrospective. Only the first episode per patient was included. CDI was defined as a positive test result using the GeneXpert assay (Cepheid) and documentation of diarrhea. Infectious Diseases Society of America (IDSA) criteria were used to classify CDI severity. 6 Nonsevere and severe CDI were defined as a white blood cell (WBC) count≤ 15,000 cells/mL and WBC count≥ 15,000 cells/mL, respectively. Fulminant CDI required the presence of hypotension or shock, megacolon, or ileus. IDSA criteria also include serum creatinine values but these were excluded in the study definitions.
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影响因子：
13.2
作者：
Wetmore, James B.;Li, Suying;Collins, Allan J.
通讯作者：
Collins, Allan J.
影响因子：
4.5
作者：
D'Agata, Erika M. C.;Lindberg, Curt C.;Rosen, Sophia
通讯作者：
Rosen, Sophia
影响因子：
4.5
作者：
Stevens, Vanessa W.;Shoemaker, Holly E.;Rubin, Michael A.
通讯作者：
Rubin, Michael A.
影响因子：
4.5
作者：
Sheth, Heena;Bernardini, Judith;Piraino, Beth
通讯作者：
Piraino, Beth
影响因子：
11.8
作者：
McDonald, L. Clifford;Gerding, Dale N.;Wilcox, Mark H.
通讯作者：
Wilcox, Mark H.