Memorial Hospital of Rhode Island, Pawtucket, Rhode Island 02860, USA.
Infect Control Hosp Epidemiol. 2012 Nov;33(11):1101-6. doi: 10.1086/668015. Epub 2012 Sep 24.
To determine, among patients with Clostridium difficile infection (CDI) at hospital admission, the impact of concurrent use of systemic, non-CDI-related antimicrobials on clinical outcomes and the risk factors associated with unnecessary antimicrobial prescribing.
Retrospective cohort study.
University-affiliated community hospital.
We reviewed computerized medical records for all patients with CDI at hospital admission during a 24-month period (January 1, 2008, through December 31, 2009). Colectomy, discharge to hospice, and in-hospital mortality were considered to be adverse outcomes. Antimicrobial use was considered unnecessary in the absence of physical signs and laboratory or radiological findings suggestive of an infection other than CDI or in the absence of antimicrobial activity against the organism(s) recovered from clinical cultures.
Among the 94 patients with CDI at hospital admission, 62% received at least one non-CDI-related antimicrobial during their hospitalization for CDI. Severe complicated CDI (odds ratio [OR], 7.1 [95% confidence interval {CI}, 1.8-28.5]; [Formula: see text]), duration of non-CDI-related antimicrobial exposure (OR, 1.2 [95% CI, 1.03-1.36]; [Formula: see text]), and age (OR, 1.1 [95% CI, 1.0-1.1]; [Formula: see text]) were independent risk factors for adverse clinical outcomes. One-third of the patients received unnecessary antimicrobial therapy. Sepsis at hospital admission (OR, 5.3 [95% CI, 1.8-15.8]; [Formula: see text]) and clinical suspicion of urinary tract infection (OR, 9.7 [95% CI, 2.9-32.3]; [Formula: see text]) were independently associated with unnecessary antimicrobial prescriptions.
Empirical use of non-CDI-related antimicrobials was common. Prolonged exposure to non-CDI-related antimicrobials was associated with adverse clinical outcomes, including increased in-hospital mortality. Minimizing non-CDI-related antimicrobial exposure in patients with CDI seems warranted.
在入院时患有艰难梭菌感染（CDI）的患者中，确定同时使用全身非 CDI 相关抗菌药物对临床结局的影响，以及与不必要的抗菌药物处方相关的危险因素。
回顾性队列研究。
大学附属社区医院。
我们回顾了 24 个月期间（2008 年 1 月 1 日至 2009 年 12 月 31 日）所有入院时患有 CDI 的患者的计算机化医疗记录。结肠切除术、临终关怀出院和院内死亡率被认为是不良结局。如果没有物理体征和实验室或放射学检查结果提示除 CDI 以外的感染，或者如果从临床培养物中回收的微生物对所用的抗菌药物没有活性，则认为抗菌药物的使用是不必要的。
在 94 例入院时患有 CDI 的患者中，有 62%的患者在因 CDI 住院期间接受了至少一种非 CDI 相关的抗菌药物。严重复杂的 CDI（比值比[OR]，7.1[95%置信区间{CI}，1.8-28.5]；[公式：见正文]）、非 CDI 相关抗菌药物暴露的持续时间（OR，1.2[95%CI，1.03-1.36]；[公式：见正文]）和年龄（OR，1.1[95%CI，1.0-1.1]；[公式：见正文]）是不良临床结局的独立危险因素。三分之一的患者接受了不必要的抗菌药物治疗。入院时脓毒症（OR，5.3[95%CI，1.8-15.8]；[公式：见正文]）和临床疑似尿路感染（OR，9.7[95%CI，2.9-32.3]；[公式：见正文]）与不必要的抗菌药物处方独立相关。
经验性使用非 CDI 相关抗菌药物很常见。非 CDI 相关抗菌药物暴露时间延长与不良临床结局相关，包括院内死亡率增加。在 CDI 患者中，减少非 CDI 相关抗菌药物的暴露似乎是合理的。
