Dasenbrock Hormuzdiyar H, Bartolozzi Arthur R, Gormley William B, Frerichs Kai U, Aziz-Sultan M Ali, Du Rose
*Neurosurgical Outcomes Center, Boston, Massachusetts; ‡Department of Neurological Surgery, Brigham and Women's Hospital, Boston, Massachusetts; §Harvard Medical School, Boston, Massachusetts.
Neurosurgery. 2016 Mar;78(3):412-20. doi: 10.1227/NEU.0000000000001065.
Clostridium difficile infection (CDI) is an important cause of hospital-acquired morbidity and mortality.
To evaluate the incidence of, predictors for, and effects on outcome by CDI after aneurysmal subarachnoid hemorrhage.
Data were extracted from the Nationwide Inpatient Sample (2002-2011). Patients with subarachnoid hemorrhage who underwent microsurgical or endovascular aneurysm repair were included. Multivariate logistic regression was used to determine the independent predictors of developing CDI. Additional models were constructed to assess the impact of CDI on mortality, length of stay, and discharge disposition.
Of the 18 007 patients who were included, 1.9% (n = 346) developed CDI. Patients who developed CDI were significantly older and had more comorbidities (P ≤ .001). Independent predictors of developing CDI were Medicaid payer status; ventriculostomy; mechanical ventilation; a greater number of noninfectious complications; and the development of a urinary tract infection; pneumonia; meningitis/ventriculitis; and sepsis (all P ≤ .02). Only 1.5% of patients with CDI required gastrointestinal surgery. Although CDI was not associated with differential mortality, it was associated with increased adjusted odds of a hospital stay of at least 24 days (odds ratio, 3.16; 95% confidence interval, 2.32-4.29; P < .001) and of a nonroutine hospital discharge (odds ratio, 1.64; 95% confidence interval, 1.13-2.39; P = .01).
In this nationwide analysis, both infectious and noninfectious complications, as well as ventriculostomy, mechanical ventilation, and insurance status were independent predictors of CDI. Although CDI was not associated with mortality, it was associated with a longer hospital stay and nonroutine hospital discharge.
艰难梭菌感染（CDI）是医院获得性发病和死亡的重要原因。
评估动脉瘤性蛛网膜下腔出血后CDI的发生率、预测因素及其对预后的影响。
数据取自全国住院患者样本（2002 - 2011年）。纳入接受显微手术或血管内动脉瘤修复的蛛网膜下腔出血患者。采用多因素逻辑回归确定发生CDI的独立预测因素。构建其他模型以评估CDI对死亡率、住院时间和出院处置的影响。
纳入的18007例患者中，1.9%（n = 346）发生CDI。发生CDI的患者年龄显著更大，合并症更多（P≤0.001）。发生CDI的独立预测因素为医疗补助支付者状态；脑室造瘘术；机械通气；更多的非感染性并发症；以及发生尿路感染、肺炎、脑膜炎/脑室炎和脓毒症（所有P≤0.02）。仅1.5%的CDI患者需要胃肠手术。虽然CDI与死亡率差异无关，但与住院至少24天的调整后几率增加相关（比值比，3.16；95%置信区间，2.32 - 4.29；P < 0.001），以及与非常规出院的几率增加相关（比值比，1.64；95%置信区间，1.13 - 2.39；P = 0.01）。
在这项全国性分析中，感染性和非感染性并发症以及脑室造瘘术、机械通气和保险状态都是CDI的独立预测因素。虽然CDI与死亡率无关，但与住院时间延长和非常规出院相关。
