Clinical Predictors of Recurrence After Primary Clostridioides difficile Infection: A Prospective Cohort Study.
Clinical Predictors of Recurrence After Primary Clostridioides difficile Infection: A Prospective Cohort Study.
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DOI：
10.1007/s10620-019-05900-3
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发表时间：
2020-06
影响因子：
3.1
通讯作者：
Bry L
中科院分区：
文献类型：
--
作者：
Allegretti JR;Marcus J;Storm M;Sitko J;Kennedy K;Gerber GK;Bry L
复发性艰难梭菌感染（CDI）是一个主要的公共卫生威胁。虽然存在临床预测工具，但它们不包含最新的美国传染病学会指南。首次发生无并发症CDI患者的前瞻性纵向研究。从诊断到完成抗CDI治疗后8周对患者进行随访，以评估复发情况。在诊断时和治疗后8周每周收集粪便。复发定义为腹泻以及C毒素EIA（EIA）粪便试验阳性。很难对二元变量进行Fisher精确检验，对连续变量进行Student t检验。进行考克斯回归以评估CDI复发的预测因子。2015年8月1日至2018年9月1日期间入组了75例患者。平均年龄58.1 ± 15.5岁，69.3%为女性，74.7%为白色，11.3%基线时患有肠易激综合征，54.7%正在积极使用PPI。在8周的随访期内，22例患者发生了确认的CDI复发。复发的单变量预测因素包括甲硝唑治疗（40.9% vs 15.1%，p=0.03），EIA初步诊断（77.3% vs 43.4%，p=0.007）和血小板计数（206 +/-72.1 vs 270.9 +/-114.8，p=0.03）。考克斯回归模型显示EIA初步诊断（HR 3.39，95%CI 1.23，9.31，p=0.018）和甲硝唑治疗（HR 3.27，95%CI 1.31-8.19，p=0.01）仍然是CDI复发的预测因子。在一个大型的前瞻性纵向队列的无并发症的CDI患者，甲硝唑治疗，并通过EIA诊断是最强大的预测CDI复发。
Recurrent Clostridioides difficile infection (CDI) is a major public health threat. While clinical prediction tools exist, they do not incorporate the newest Infectious Diseases Society of America guidelines. Prospective longitudinal study of patients experiencing their first episode of uncomplicated CDI. Patients were followed from diagnosis through 8 weeks post completion of their anti-CDI therapy to assess recurrence. Stool was collected at diagnosis and weekly for 8-weeks following treatment. Recurrence was defined as diarrhea as well as a positive stool test by toxin EIA (EIA) for C. difficile. Fisher’s exact test for binary variables and student’s t-test for continuous variables were performed. Cox regression was performed to assess for predictors of CDI recurrence. 75 patients were enrolled between Aug 1, 2015 and Sept 1, 2018. Mean age 58.1 years +/− 15.5, 69.3% female, 74.7% were white, 11.3% had baseline irritable bowel syndrome, and 54.7% were actively using PPIs. Over the 8-week follow up period 22 patients developed a confirmed CDI recurrence. Univariate predictors of recurrence included treatment with metronidazole (40.9% vs 15.1%, p=0.03), initially diagnosis by EIA (77.3% vs 43.4%, p=0.007) and platelet count (206 +/− 72.1 vs 270.9 +/− 114.8, p=0.03). A cox regression model revealed primary diagnosis by EIA (HR 3.39, 95%CI 1.23, 9.31, p=0.018) and treatment with metronidazole (HR 3.27 95% CI 1.31–8.19, p=0.01) remain predictors for CDI recurrence. In a large prospective longitudinal cohort of uncomplicated CDI patients, treatment with metronidazole, and diagnosis via EIA were the most robust predictors of CDI recurrence.
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影响因子：
4.1
作者：
Reveles KR;Mortensen EM;Koeller JM;Lawson KA;Pugh MJV;Rumbellow SA;Argamany JR;Frei CR
通讯作者：
Frei CR
影响因子：
4.8
作者：
Fletcher JR;Erwin S;Lanzas C;Theriot CM
通讯作者：
Theriot CM
DOI：
10.1016/j.ijantimicag.2017.09.010
发表时间：
2018-03-01
影响因子：
10.8
作者：
Cobo, Javier;Merino, Esperanza;Fernandez-Felix, Borja M.
通讯作者：
Fernandez-Felix, Borja M.
影响因子：
7.6
作者：
Khanna S;Montassier E;Schmidt B;Patel R;Knights D;Pardi DS;Kashyap P
通讯作者：
Kashyap P
影响因子：
14.2
作者：
Crobach, M. J. T.;Planche, T.;Kuijper, E. J.
通讯作者：
Kuijper, E. J.