Division of Pediatric Hematology-Oncology, Department of Pediatrics, Case Western Reserve University, Cleveland, OH 44106, USA.
J Pediatr. 2013 Sep;163(3):699-705.e1. doi: 10.1016/j.jpeds.2013.01.062. Epub 2013 Mar 8.
To study the trend of Clostridium difficile infection (CDI) and risk factors for hospital acquired CDI (HA-CDI) among children with cancer.
We analyzed 33 095 first pediatric hospitalizations for malignancy among 43 pediatric hospitals between 1999 and 2011. The effect of demographics, disease characteristics, and weekly drug exposure (antibiotics, antacids, and chemotherapy) on HA-CDI was assessed with multivariate Cox regression. CDI was defined by the combination of International Classification of Diseases, 9th edition-Clinical Modification (ICD-9CM), CDI diagnostic assay billing code, and concurrent administration of a CDI-active antibiotic. HA-CDI was defined as CDI with assay occurring after the sixth hospital day.
A total of 1736 admissions with CDI were identified, of which 380 were HA-CDI. CDI incidence increased from 1999-2006 (P = .01); however, CDI testing frequency and disease decreased from 2006-2010 (P < .05). Admissions with HA-CDI had longer lengths of stay compared with those without HA-CDI (35 days vs 12 days, P < .01) and greater risk of inpatient mortality (relative risk 2.3, P < .01). Increased risk of HA-CDI (hazard ratio [95% CI]) was seen after exposure to the following drugs: aminoglycoside (1.357 [1.053-1.749]), third generation cephalosporin (1.518 [1.177-1.959]), cefepime (2.383 [1.839-3.089]), and proton pump inhibiting agent (1.398 [1.096-1.784]) in the prior week, and chemotherapy (1.942 [1.491-2.529]) in the 8-14 days prior to HA-CDI onset. Histamine-2 receptor antagonist exposure in the prior week was associated with decreased risk of HA-CDI (0.730 [0.584-0.912]).
Despite an apparent decrease in CDI incidence from 2006-2010, HA-CDI remains prevalent and morbid among children with cancer. Recent exposure to chemotherapy, proton pump inhibitor, and certain antibiotics were independent risk factors for HA-CDI.
研究儿童癌症患者艰难梭菌感染（CDI）的趋势和医院获得性 CDI（HA-CDI）的危险因素。
我们分析了 1999 年至 2011 年间 43 家儿童医院的 33095 例儿科首次住院治疗恶性肿瘤的病例。采用多变量 Cox 回归评估人口统计学、疾病特征和每周药物暴露（抗生素、抗酸剂和化疗）对 HA-CDI 的影响。CDI 的定义是国际疾病分类第 9 版临床修订版（ICD-9CM）、CDI 诊断检测计费代码和同时使用 CDI 活性抗生素的组合。HA-CDI 定义为在第六个住院日后发生的 CDI 检测。
共确定了 1736 例 CDI 入院病例，其中 380 例为 HA-CDI。1999-2006 年期间，CDI 的发病率有所上升（P=0.01）；然而，2006-2010 年期间，CDI 检测的频率和疾病减少（P<0.05）。与无 HA-CDI 的住院患者相比，HA-CDI 住院患者的住院时间更长（35 天与 12 天，P<0.01），且住院死亡率的风险更高（相对风险 2.3，P<0.01）。在前一周内接触氨基糖苷类（1.357[1.053-1.749]）、第三代头孢菌素（1.518[1.177-1.959]）、头孢吡肟（2.383[1.839-3.089]）和质子泵抑制剂（1.398[1.096-1.784]），以及在 HA-CDI 发病前 8-14 天内接触化疗药物（1.942[1.491-2.529]）的患者发生 HA-CDI 的风险增加。在前一周内接触组胺 2 受体拮抗剂与 HA-CDI 风险降低相关（0.730[0.584-0.912]）。
尽管 2006-2010 年 CDI 的发病率似乎有所下降，但儿童癌症患者的 HA-CDI 仍然普遍存在且病情严重。最近接触化疗、质子泵抑制剂和某些抗生素是 HA-CDI 的独立危险因素。
