Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Clin Gastroenterol Hepatol. 2010 Nov;8(11):961-5. doi: 10.1016/j.cgh.2010.07.017. Epub 2010 Aug 17.
BACKGROUND & AIMS: Hospitalized patients with inflammatory bowel disease (IBD) could be at increased risk for hospital-acquired infections (HAIs). By using HAI outcome data from Pennsylvania, we examined the influence of HAIs on in-patient mortality and length of stay (LOS) in the hospital among patients with IBD.
Data were generated by linking the Clinical Research Databases from CareFusion (formerly MediQual), which includes all acute care hospitals in Pennsylvania, with publicly reported HAI data from Pennsylvania. The study population included all patients discharged in 2004 with International Classification of Diseases, 9th Clinical Modification codes of 555.x or 556.x (2324 IBD cases from 161 hospitals). Controls were selected using risk-score matching with a 5:1 ratio. Mortality and LOS end points were estimated and corroborated with regression methods.
Among the IBD patients studied, there were 20 deaths and 22 reported cases of HAI. The mortality from HAI among patients with IBD was 13.6%, compared with 0.9% among controls (P = .0146, Fisher exact test). The odds ratio for mortality was 17.2 (95% confidence interval, 1.7-174.3). The median LOS for patients with IBD and HAI was 22 days, versus 6 days for controls (P < .001, Wilcoxon). Of the 22 cases with HAIs, 15 were urinary tract infections, 5 were blood stream infections, and 2 were from multiple sources.
Results from a population-based data set indicate that mortality and LOS are increased among IBD patients who develop HAIs. A majority of the HAIs were from urinary sources. Although HAIs are low-frequency events, increased vigilance to avoid HAI among patients with IBD could improve outcomes.
患有炎症性肠病（IBD）的住院患者可能面临更高的医院获得性感染（HAI）风险。我们利用宾夕法尼亚州的 HAI 结果数据，研究了 HAI 对 IBD 患者住院期间的院内死亡率和住院时间（LOS）的影响。
数据由 CareFusion（前身为 MediQual）的临床研究数据库生成，该数据库包含宾夕法尼亚州所有的急性护理医院，并与宾夕法尼亚州公开报告的 HAI 数据相关联。研究人群包括 2004 年出院的所有患者，其国际疾病分类，第 9 临床修正版代码为 555.x 或 556.x（来自 161 家医院的 2324 例 IBD 病例）。使用风险评分匹配，以 5:1 的比例选择对照。死亡率和 LOS 终点通过估计和回归方法进行验证。
在所研究的 IBD 患者中，有 20 例死亡和 22 例 HAI 报告病例。IBD 患者的 HAI 死亡率为 13.6%，而对照组为 0.9%（P=0.0146，Fisher 确切检验）。死亡率的比值比为 17.2（95%置信区间，1.7-174.3）。IBD 合并 HAI 患者的中位 LOS 为 22 天，而对照组为 6 天（P<0.001，Wilcoxon）。在 22 例 HAI 病例中，15 例为尿路感染，5 例为血流感染，2 例为多源感染。
基于人群数据集的结果表明，发生 HAI 的 IBD 患者的死亡率和 LOS 增加。大多数 HAI 来自尿源。尽管 HAI 是低频事件，但提高对 IBD 患者 HAI 的警惕性可以改善结局。
