Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Biol Blood Marrow Transplant. 2013 Oct;19(10):1502-8. doi: 10.1016/j.bbmt.2013.07.022. Epub 2013 Aug 1.
We sought to describe the epidemiology of Clostridium difficile infection (CDI) among adult recipients of autologous hematopoietic stem cell transplantation (auto-HSCT) within the first year after HSCT in centers with variable epidemiology of hypertoxigenic strains. A multicenter, retrospective nested case-control study was conducted among 873 auto-HSCT recipients at Johns Hopkins Hospital (JHH) and Hôpital Maisonneuve-Rosemont (HMR) between January 2003 and December 2008. Despite center differences in the prevalence of NAP-1 strains during the study period (21% to 43% at JHH versus 80% to 84% in HMR), the 1-year incidence of CDI was similar in the 2 hospitals (6.2% at JHH versus 5.7% at HMR). The median time to infection was 11 days (interquartile range, 1 to 27 days). In case-control analyses, grade ≥2 mucositis (odds ratio [OR], 3.00; P = .02) and receipt of a fourth-generation cephalosporin (OR, 2.76; P = .04) were identified as predictors for CDI. Mucositis was the strongest predictor of risk for CDI in multivariate analysis (adjusted OR, 2.77; P = .03). CDI is a common and early complication of auto-HSCT. Treatment-related gastrointestinal mucosal damage, along with the potentially modifiable risk of antimicrobial exposure, influence the risk for CDI early after auto-HSCT.
我们旨在描述在具有不同高毒力菌株流行病学特征的中心中，自体造血干细胞移植（auto-HSCT）后 1 年内成年患者的艰难梭菌感染（CDI）的流行病学。在约翰霍普金斯医院（JHH）和蒙特利尔 Maisonneuve-Rosemont 医院（HMR），进行了一项多中心、回顾性巢式病例对照研究，纳入了 2003 年 1 月至 2008 年 12 月期间 873 名接受 auto-HSCT 的患者。尽管在研究期间中心间 NAP-1 菌株的流行率存在差异（JHH 为 21%至 43%，HMR 为 80%至 84%），但 2 家医院的 1 年 CDI 发生率相似（JHH 为 6.2%，HMR 为 5.7%）。感染的中位时间为 11 天（四分位间距，1 至 27 天）。在病例对照分析中，≥2 级粘膜炎（比值比[OR]，3.00；P =.02）和使用第四代头孢菌素（OR，2.76；P =.04）被确定为 CDI 的预测因素。在多变量分析中，粘膜炎是 CDI 风险的最强预测因素（调整 OR，2.77；P =.03）。CDI 是 auto-HSCT 的常见且早期并发症。与治疗相关的胃肠道黏膜损伤以及潜在可改变的抗菌药物暴露风险，影响了 auto-HSCT 后早期 CDI 的风险。
