Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Republic of Korea.
Support Care Cancer. 2014 Aug;22(8):2039-48. doi: 10.1007/s00520-014-2174-7. Epub 2014 Mar 5.
This study aimed at evaluating the clinical severity and treatment outcomes of Clostridium difficile infections (CDI) and identifying predictors associated with mortality in patients with malignancy.
A retrospective study was conducted in a teaching hospital from January 2004 to June 2013. The subjects included adult patients (aged ≥ 18 years) receiving treatment for malignancy whose conditions were complicated by CDI. Clinical severity was determined using the guidelines from the Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America (SHEA/IDSA). Multivariate logistic regression analysis was performed to identify predictors independently associated with CDI-related mortality.
Of the 5,594 patients treated for malignancy at the Division of Hematology/Oncology during the study period, 61 (1.1%) had CDI complications. CDI-related mortality was 19.7% (12/61). Twenty-seven (44.3%) patients were diagnosed with neutropenia (ANC ≤ 500/mm(3)) at initial CDI presentation. Forty-one patients (67.2%) received antimicrobial therapy for CDI. Based on the SHEA/IDSA guidelines, only 12 patients (19.7%) presented with severe CDI, but 25 (61.0%) patients experienced treatment failure. Multiple logistic regression modeling showed neutropenia to be an independent risk factor for CDI-related mortality (odds ratio, 5.17; 95% confidence interval, 1.24-21.59).
This study tracked poor CDI treatment outcomes in patients with malignancy and identified neutropenia as a previously unrecognized risk factor of CDI-related mortality. Alternative definitions of severe CDI that include neutropenia might be necessary to more accurately determine clinical severity.
本研究旨在评估艰难梭菌感染（CDI）的临床严重程度和治疗结局，并确定与恶性肿瘤患者死亡相关的预测因素。
本研究为回顾性研究，于 2004 年 1 月至 2013 年 6 月在一家教学医院进行。研究对象为接受恶性肿瘤治疗且病情合并 CDI 的成年患者（年龄≥18 岁）。临床严重程度采用美国医疗保健流行病学学会和感染病学会（SHEA/IDSA）指南进行判断。采用多变量逻辑回归分析确定与 CDI 相关死亡率独立相关的预测因素。
在研究期间，血液肿瘤科共收治了 5594 例恶性肿瘤患者，其中 61 例（1.1%）出现 CDI 并发症。CDI 相关死亡率为 19.7%（12/61）。27 例（44.3%）患者在初次 CDI 时被诊断为中性粒细胞减少症（ANC≤500/mm3）。41 例（67.2%）患者接受了针对 CDI 的抗菌治疗。根据 SHEA/IDSA 指南，仅有 12 例（19.7%）患者表现为严重 CDI，但 25 例（61.0%）患者治疗失败。多变量逻辑回归模型显示中性粒细胞减少症是 CDI 相关死亡率的独立危险因素（比值比，5.17；95%置信区间，1.24-21.59）。
本研究追踪了恶性肿瘤患者中 CDI 治疗效果不佳的情况，并确定中性粒细胞减少症是 CDI 相关死亡率的一个以前未被认识到的危险因素。纳入中性粒细胞减少症的严重 CDI 替代定义可能有助于更准确地判断临床严重程度。
