Zacharioudakis Ioannis M, Ziakas Panayiotis D, Mylonakis Eleftherios
Infectious Diseases Division, Rhode Island Hospital, Providence, Rhode Island; Warren Alpert Medical School of Brown University, Providence, Rhode Island.
Infectious Diseases Division, Rhode Island Hospital, Providence, Rhode Island; Warren Alpert Medical School of Brown University, Providence, Rhode Island.
Biol Blood Marrow Transplant. 2014 Oct;20(10):1650-4. doi: 10.1016/j.bbmt.2014.06.001. Epub 2014 Jun 7.
Hematopoietic stem cell transplant (HSCT) recipients are at high risk of contracting Clostridium difficile infection (CDI). We systematically searched the PubMed and EMBASE databases through March 2014 and performed a random-effects meta-analysis to estimate the prevalence and trends of CDI over time. Among 48 eligible articles that included 12,025 patients at risk, we estimated that 7.9% (95% confidence interval [CI], 6.5% to 9.5%) of HSCT patients are diagnosed with CDI during the peri-transplantation and late post-transplantation periods, an estimation that is relatively consistent across studies (τ(2) = .032). Prevalence of CDI is significantly higher among the 5120 allogeneic patients (9.3% [95% CI, 7.0% to 11.9%]), compared with the 4665 autologous patients (5.2% [95% CI, 3.8% to 6.9%]) (P = .02), and as many as 1 of 10 allogeneic transplant recipients are expected to be diagnosed with CDI compared with 1 of 20 autologous transplantation patients. However, this difference did not reach statistical significance when stratified data from the same centers were examined (P = .11). Importantly, we found an increasing trend of CDI diagnosis both worldwide (P = .02) and across studies conducted in North America (P = .03) over the last 34 years. Notably, studies with a follow-up period that extended through the late post-transplantation period (after day +100) had a similar prevalence of CDI as those that followed patients only during the peri-transplantation period (up to day +100) (P = .94). In summary, CDI is common in the hematopoietic transplantation setting and the majority of infections occur in the peri-transplantation period. The prevalence is almost 9-times higher than that reported among all hospital stays, with an increasing trend over time.
造血干细胞移植（HSCT）受者感染艰难梭菌（CDI）的风险很高。我们系统检索了截至2014年3月的PubMed和EMBASE数据库，并进行了随机效应荟萃分析，以估计CDI随时间的患病率和趋势。在纳入12025名有风险患者的48篇合格文章中，我们估计7.9%（95%置信区间[CI]，6.5%至9.5%）的HSCT患者在移植围手术期和移植后期被诊断为CDI，这一估计在各研究中相对一致（τ(2)=0.032）。与4665名自体移植患者（5.2%[95%CI，3.8%至6.9%]）相比，5120名异体移植患者中CDI的患病率显著更高（9.3%[95%CI，7.0%至11.9%]）（P=0.02），预计每10名异体移植受者中就有1人会被诊断为CDI，而自体移植患者中这一比例为20分之一。然而，当检查来自同一中心的分层数据时，这种差异没有达到统计学意义（P=0.11）。重要的是，我们发现在过去34年中，全球范围内（P=0.02）以及在北美进行的研究中（P=0.03），CDI诊断呈上升趋势。值得注意的是，随访期延长至移植后期（第100天之后）的研究中CDI的患病率与仅在移植围手术期（至第100天）对患者进行随访的研究相似（P=0.94）。总之，CDI在造血移植环境中很常见，大多数感染发生在移植围手术期。其患病率几乎比所有住院患者报告的患病率高9倍，且呈随时间上升的趋势。
