Guddati Achuta Kumar, Kumar Gagan, Ahmed Shahryar, Ali Muhammad, Kumar Nilay, Hari Parameswaran, Venu Nanda
Division of Internal Medicine, Massachusetts General Hospital, Harvard Medical School, 50 Fruit Street, Boston, MA, USA,
Int J Hematol. 2014 Jun;99(6):758-65. doi: 10.1007/s12185-014-1577-z. Epub 2014 Apr 9.
Hematopoietic stem cell transplant (HSCT) recipients are at a high risk of Clostridium difficile-associated disease (CDAD) given frequent hospitalizations, prolonged antibiotic usage and altered integrity of intestinal mucosa. The prevalence and trends of CDAD in HSCT patients have not been extensively studied. In this study, the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes were used to identify CDAD in HSCT patients using a nationwide inpatient sample in the United States from 2000 to 2009. The prevalence of CDAD and in-hospital mortality in HSCT were investigated and compared to those without any transplants. Multivariate analysis was performed to identify if BMT and graft versus host disease (GVHD) were independently associated with mortality in CDAD patients. Of the 344,507 HSCT discharges, 4.7 % had CDAD. This was about 5 times higher when compared to non-transplant discharges. During engraftment admission, rates of CDAD were higher in allogenic group (8.4 vs. 5.7 %, p < 0.001). In subsequent admissions, those with GVHD had higher rates of CDAD (5.7 vs. 3.2 %, p < 0.001). On adjusted analysis in patients with CDAD, during engraftment admission, allogenic group had significantly higher mortality when compared with non-transplants (OR 3.7). Notably, there was no significant difference in mortality between patients with and without CDAD during the engraftment period for the allogeneic group. In subsequent admissions, there was higher mortality in those with GVHD (OR 4.8). Though the prevalence of CDAD in non-transplant population doubled (from 0.44 % in 2000 to 0.99 % in 2008), it has remained stable in HSCT patients (from 4.8 % in 2000 to 5.6 % in 2008). HSCT and GVHD are independently associated with CDAD though its presence does not affect mortality.
造血干细胞移植（HSCT）受者由于频繁住院、长期使用抗生素以及肠道黏膜完整性改变，患艰难梭菌相关疾病（CDAD）的风险很高。HSCT患者中CDAD的患病率和趋势尚未得到广泛研究。在本研究中，使用国际疾病分类第九版临床修订本（ICD-9-CM）编码，通过美国2000年至2009年的全国住院患者样本，识别HSCT患者中的CDAD。对HSCT中CDAD的患病率和住院死亡率进行了调查，并与未进行任何移植的患者进行了比较。进行多变量分析，以确定骨髓移植（BMT）和移植物抗宿主病（GVHD）是否与CDAD患者的死亡率独立相关。在344,507例HSCT出院病例中，4.7%患有CDAD。与非移植出院病例相比，这一比例高出约5倍。在植入期入院时，异基因组的CDAD发生率更高（8.4%对5.7%，p<0.001）。在随后的入院中，患有GVHD的患者CDAD发生率更高（5.7%对3.2%，p<0.001）。在对CDAD患者进行校正分析时，在植入期入院时，异基因组与非移植患者相比死亡率显著更高（比值比3.7）。值得注意的是，在异基因组的植入期，有CDAD和无CDAD的患者死亡率没有显著差异。在随后的入院中，患有GVHD的患者死亡率更高（比值比4.8）。虽然非移植人群中CDAD的患病率翻了一番（从2000年的0.44%升至2008年的0.99%），但在HSCT患者中保持稳定（从2000年的4.8%升至2008年的5.6%）。HSCT和GVHD与CDAD独立相关，尽管其存在不影响死亡率。
