Pant C, Anderson M P, O'Connor J A, Marshall C M, Deshpande A, Sferra T J
Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
Transpl Infect Dis. 2012 Oct;14(5):540-7. doi: 10.1111/j.1399-3062.2012.00761.x. Epub 2012 Jun 22.
Diarrhea is a frequent and potentially severe complication in solid organ transplant (SOT) recipients. One of the most common infectious etiologies of diarrhea in these patients is Clostridium difficile. Our objective was to investigate the association of C. difficile infection (CDI) with the outcomes of hospitalized SOT patients.
We extracted all adult cases with discharge diagnoses of SOT or CDI from the United States Nationwide Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality 2009 database. We collected outcome variables (mortality, length of hospital stay [LOS], hospitalization charges, complications of the transplanted organ, and colectomy), demographic information, and comorbidity data for each of the cases. The data were evaluated using univariate and multiple variable regression analyses.
We identified 49,198 cases with SOT of which 2.7% had CDI. Univariate comparisons of cases with SOT + CDI to those with SOT-only revealed significant differences in the evaluated outcomes including in-hospital mortality (7.4% vs. 2.4%, P < 0.001), LOS (median 9 days vs. 4 days, P < 0.001), charges (median $53,808 vs. $31,488, P < 0.001), organ complications (38.1% vs. 33.9%, P < 0.001), and colectomy (1.1% vs. 0.3%, P < 0.001). Using multiple variable regression analyses, in the SOT cohort (SOT-only and SOT + CDI), CDI was independently associated with greater mortality (adjusted odds ratio [aOR] 2.48, 95% confidence interval [CI] = 2.22, 2.76, P < 0.001), longer LOS (difference 9.6 days, 95% CI = 9.3, 9.9, P < 0.001), higher charges (difference $69,647, 95% CI = $66,190, $73,104, P < 0.001), more complications of the transplanted organ (aOR 1.36, 95% CI = 1.28, 1.44, P < 0.001), and increased need for colectomy (aOR 3.10, 95% CI = 2.35, 4.08, P < 0.001).
Our results demonstrate that CDI is associated with overall significantly worse outcomes in hospitalized patients with SOT.
腹泻是实体器官移植（SOT）受者常见且可能严重的并发症。这些患者腹泻最常见的感染病因之一是艰难梭菌。我们的目的是研究艰难梭菌感染（CDI）与住院SOT患者结局之间的关联。
我们从美国全国住院样本、医疗保健成本与利用项目、医疗保健研究与质量机构2009年数据库中提取了所有出院诊断为SOT或CDI的成年病例。我们收集了每个病例的结局变量（死亡率、住院时间[LOS]、住院费用、移植器官并发症和结肠切除术）、人口统计学信息和合并症数据。使用单变量和多变量回归分析对数据进行评估。
我们确定了49198例SOT病例，其中2.7%患有CDI。将SOT + CDI病例与仅SOT病例进行单变量比较，结果显示在评估的结局方面存在显著差异，包括住院死亡率（7.4%对2.4%，P < 0.001）、LOS（中位数9天对4天，P < 0.001）、费用（中位数53808美元对31488美元，P < 0.001）、器官并发症（38.1%对33.9%，P < 0.001）和结肠切除术（1.1%对0.3%，P < 0.001）。使用多变量回归分析，在SOT队列（仅SOT和SOT + CDI）中，CDI与更高的死亡率（调整优势比[aOR] 2.48，95%置信区间[CI] = 2.22，2.76，P < 0.001）、更长的LOS（差异9.6天，95% CI = 9.3，9.9，P < 0.001）、更高的费用（差异69647美元，95% CI = 66190美元，73104美元，P < 0.001）、更多的移植器官并发症（aOR 1.36，95% CI = 1.28，1.44，P < 0.001）以及增加的结肠切除术需求（aOR 3.10，95% CI = 2.35，4.08，P < 0.001）独立相关。
我们的结果表明，CDI与住院SOT患者总体上明显更差的结局相关。
