Feinberg School of Medicine, Northwestern University, 250 E. Superior Street, Chicago, IL 60611, USA.
Biol Blood Marrow Transplant. 2013 Mar;19(3):405-9. doi: 10.1016/j.bbmt.2012.10.030. Epub 2012 Dec 4.
The incidence and severity of Clostridium difficile-associated disease (CDAD) within the general population has risen dramatically over the past decade, yet little data are available from hematopoietic stem cell transplantation (HSCT) centers. In the present study, we performed a chart review of 822 consecutive autologous and allogeneic HCST recipients treated at Northwestern Memorial Hospital between 2004 and 2008 to determine the incidence of CDAD at our institution. Variables including age, sex, diagnosis, chemotherapy regimen, transplantation type, microbial colonization, coinfections, diet, antibiotic use, neutropenic fever, comorbid conditions, time to engraftment, growth factor administration, and occurrence of graft-versus-host disease were assessed as potential risk factors for the development of CDAD. Eighty-five CDAD cases (10.3%) were identified. Bivariate analysis revealed a significant association between CDAD and neutropenic fever, administration of a neutropenic diet, ciprofloxacin and aztreonam use and duration of therapy, vancomycin and aztreonam use and duration of therapy, receipt of an allogeneic transplantation, bacterial coinfection, and vancomycin-resistant Entereococcus faecium (VRE) colonization. Cox regression analysis identified the following as factors associated with the development of CDAD: age >60 years, allogeneic transplantation, and prior VRE colonization. Allogeneic recipients with CDAD experienced increased higher rates of grades II to IV gastrointestinal graft-versus-host disease and nonrelapse mortality. A risk stratification model was developed to identify HSCT recipients at different levels of risk. With an incidence >10%, CDAD is a significant infectious complication of stem cell transplantation.
在过去的十年中，普通人群中艰难梭菌相关性疾病（CDAD）的发病率和严重程度急剧上升，但来自造血干细胞移植（HSCT）中心的数据却很少。在本研究中，我们对 2004 年至 2008 年期间在西北纪念医院接受治疗的 822 例连续的自体和同种异体 HSCT 受者进行了图表回顾，以确定我们机构中 CDAD 的发生率。年龄、性别、诊断、化疗方案、移植类型、微生物定植、合并感染、饮食、抗生素使用、中性粒细胞减少性发热、合并症、植入时间、生长因子管理以及移植物抗宿主病的发生等变量被评估为 CDAD 发展的潜在危险因素。确定了 85 例 CDAD 病例（10.3%）。双变量分析显示，CDAD 与中性粒细胞减少性发热、使用中性粒细胞减少饮食、环丙沙星和氨曲南的使用和治疗时间、万古霉素和氨曲南的使用和治疗时间、接受同种异体移植、细菌合并感染和万古霉素耐药粪肠球菌（VRE）定植之间存在显著相关性。Cox 回归分析确定与 CDAD 发展相关的因素为：年龄>60 岁、同种异体移植和先前的 VRE 定植。患有 CDAD 的同种异体受者经历了更高比例的 II 至 IV 级胃肠道移植物抗宿主病和非复发死亡率。建立了一种风险分层模型，以确定不同风险水平的 HSCT 受者。CDAD 的发病率>10%，是干细胞移植的重要感染并发症。
