Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA, USA.
J Antimicrob Chemother. 2014 Apr;69(4):1127-31. doi: 10.1093/jac/dkt489. Epub 2013 Dec 9.
The main objective of this study was to determine patient- and hospital-level medication risk factors associated with Clostridium difficile infection (CDI) occurrence among patients clustered within hospitals using a multilevel model.
Patients with healthcare-associated (HA)-CDI were identified from among 64 academic medical centres in 2009. A frequency match was conducted; for each case, up to two controls were selected, matched on similar pre-infection length of stay and clinical service line. Patient- and hospital-level medication use, including antibacterial and gastric acid-suppressant agents, was assessed using a two-level logistic regression model.
A total of 5967 CDI cases and 8167 controls were included in the analysis. The odds of acquiring HA-CDI increased with the following medications [OR (95% CI)]: anti-methicillin-resistant Staphylococcus aureus agents [1.38 (1.22-1.56)]; third- or fourth-generation cephalosporins [1.75 (1.62-1.89)]; carbapenems [1.60 (1.44-1.79)]; β-lactam/β-lactamase inhibitor combinations [1.49 (1.36-1.64)]; vancomycin [1.73 (1.57-1.89)]; and proton pump inhibitors [1.43 (1.30-1.57)]. The odds of acquiring HA-CDI decreased with the following medications: clindamycin [0.74 (0.63-0.87)]; and macrolides [0.88 (0.77-0.99)]. Controlling for patient-level covariates, no hospital-level medication covariates that we analysed had statistically significant effects on HA-CDI. The odds of acquiring HA-CDI increased with the hospital proportion of patients aged ≥ 65 years [1.01 (1.00-1.02)].
We found several medications that were associated with the risk of patients developing HA-CDI, including β-lactam/β-lactamase inhibitor combinations, third- or fourth-generation cephalosporins, carbapenems, vancomycin, proton pump inhibitors and anti-methicillin-resistant S. aureus agents. There were no medication effects significant at the hospital level.
本研究的主要目的是使用多水平模型确定与医院内聚集的患者发生艰难梭菌感染（CDI）相关的患者和医院水平的药物危险因素。
2009 年，从 64 家学术医疗中心中确定了与医疗保健相关（HA）-CDI 的患者。进行了频率匹配；对于每个病例，选择了最多两个对照，与类似的感染前住院时间和临床服务线相匹配。使用两水平逻辑回归模型评估了患者和医院水平的药物使用情况，包括抗菌药物和胃酸抑制剂。
共纳入 5967 例 CDI 病例和 8167 例对照。以下药物的获得 HA-CDI 的可能性增加[比值比（95%置信区间）]：抗耐甲氧西林金黄色葡萄球菌药物[1.38（1.22-1.56）]；第三代或第四代头孢菌素[1.75（1.62-1.89）]；碳青霉烯类[1.60（1.44-1.79）]；β-内酰胺/β-内酰胺酶抑制剂组合[1.49（1.36-1.64）]；万古霉素[1.73（1.57-1.89）]；和质子泵抑制剂[1.43（1.30-1.57）]。获得 HA-CDI 的可能性降低了以下药物：克林霉素[0.74（0.63-0.87）]；和大环内酯类[0.88（0.77-0.99）]。在控制患者水平的协变量后，我们分析的任何医院水平的药物协变量对 HA-CDI 均无统计学意义。获得 HA-CDI 的可能性随着≥65 岁患者的医院比例增加而增加[1.01（1.00-1.02）]。
我们发现了一些与患者发生 HA-CDI 风险相关的药物，包括β-内酰胺/β-内酰胺酶抑制剂组合、第三代或第四代头孢菌素、碳青霉烯类、万古霉素、质子泵抑制剂和抗耐甲氧西林金黄色葡萄球菌药物。在医院水平没有药物作用显著。
