Deshpande Abhishek, Pasupuleti Vinay, Thota Priyaleela, Pant Chaitanya, Rolston David D K, Hernandez Adrian V, Donskey Curtis J, Fraser Thomas G
1Medicine Institute Center for Value Based Care Research,Cleveland Clinic,Cleveland,Ohio.
3Department of Medicine,Division of Infectious Diseases,Case Western Reserve University,Cleveland,Ohio.
Infect Control Hosp Epidemiol. 2015 Apr;36(4):452-60. doi: 10.1017/ice.2014.88. Epub 2015 Jan 28.
An estimated 20-30% of patients with primary Clostridium difficile infection (CDI) develop recurrent CDI (rCDI) within 2 weeks of completion of therapy. While the actual mechanism of recurrence remains unknown, a variety of risk factors have been suggested and studied. The aim of this systematic review and meta-analysis was to evaluate current evidence on the risk factors for rCDI.
We searched MEDLINE and 5 other databases for subject headings and text related to rCDI. All studies investigating risk factors of rCDI in a multivariate model were eligible. Information on study design, patient population, and assessed risk factors were collected. Data were combined using a random-effects model and pooled relative risk ratios (RRs) were calculated.
A total of 33 studies (n=18,530) met the inclusion criteria. The most frequent independent risk factors associated with rCDI were age≥65 years (risk ratio [RR], 1.63; 95% confidence interval [CI], 1.24-2.14; P=.0005), additional antibiotics during follow-up (RR, 1.76; 95% CI, 1.52-2.05; P<.00001), use of proton-pump inhibitors (PPIs) (RR, 1.58; 95% CI, 1.13-2.21; P=.008), and renal insufficiency (RR, 1.59; 95% CI, 1.14-2.23; P=.007). The risk was also greater in patients previously on fluoroquinolones (RR, 1.42; 95% CI, 1.28-1.57; P<.00001).
Multiple risk factors are associated with the development of rCDI. Identification of modifiable risk factors and judicious use of antibiotics and PPI can play an important role in the prevention of rCDI.
估计20%-30%的原发性艰难梭菌感染（CDI）患者在治疗结束后2周内会发生复发性CDI（rCDI）。虽然复发的实际机制尚不清楚，但已提出并研究了多种风险因素。本系统评价和荟萃分析的目的是评估目前关于rCDI风险因素的证据。
我们在MEDLINE和其他5个数据库中搜索了与rCDI相关的主题词和文本。所有在多变量模型中研究rCDI风险因素的研究均符合条件。收集了有关研究设计、患者群体和评估的风险因素的信息。使用随机效应模型合并数据，并计算汇总相对风险比（RRs）。
共有33项研究（n=18,530）符合纳入标准。与rCDI相关的最常见独立风险因素为年龄≥65岁（风险比[RR]，1.63；95%置信区间[CI]，1.24-2.14；P=0.0005）、随访期间使用其他抗生素（RR，1.76；95%CI，1.52-2.05；P<0.00001）、使用质子泵抑制剂（PPI）（RR，1.58；95%CI，1.13-2.21；P=0.008）和肾功能不全（RR，1.59；95%CI，1.14-2.23；P=0.007）。既往使用氟喹诺酮类药物的患者风险也更高（RR，1.42；95%CI，1.28-1.57；P<0.00001）。
多种风险因素与rCDI的发生相关。识别可改变的风险因素以及明智地使用抗生素和PPI对预防rCDI可起到重要作用。
