Aldrete Sol Del Mar, Kraft Colleen S, Magee Matthew J, Chan Austin, Hutcherson Don, Langston Amelia A, Greenwell Brian I, Burd Eileen M, Friedman-Moraco Rachel
Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA, USA.
Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA.
Transpl Infect Dis. 2017 Feb;19(1). doi: 10.1111/tid.12649.
Hematopoietic stem cell transplant (HSCT) recipients represent a high-risk group for developing Clostridium difficile (CD) infection (CDI). We aimed to identify specific risk factors for CDI in an HSCT patient population during the peritransplant period.
We performed a case-control study within a cohort of HSCT patients who received a transplant from November 2010 to March 2013. Cases had a clinical presentation compatible with CDI and a positive stool sample Xpert C. difficile test. Controls were CDI negative and matched on age, gender, and transplant type. Peritransplant period was defined as -30 days or time of stem cell mobilization maneuver to 30 days post transplant in autologous SCT or 90 days post transplant in allogeneic SCT.
Of 781 HSCTs performed during the study period, 650 (83.2%) had a stool sample submitted for CD testing. Eight-six (13.2%) cases with CDI were identified. Most of the cases were diagnosed within a week after transplantation (median of 5 days). In adjusted analysis, prior hospitalization (odds ratio [OR]: 2.01, 95% confidence interval [CI] 1.2-3.36), prior cephalosporin administration (OR 2.72, 95% CI: 1.54-4.83), and prior chemotherapy (OR: 3.26, 95% CI: 1.92-5.5) were significantly associated with CDI.
Hospitalization, and prior antibiotic and chemotherapy use are risk factors that are not easily modifiable, which emphasizes the need to start investigating preventive or prophylactic strategies in this high-risk population.
造血干细胞移植（HSCT）受者是发生艰难梭菌（CD）感染（CDI）的高危人群。我们旨在确定HSCT患者围移植期发生CDI的特定危险因素。
我们在一组2010年11月至2013年3月接受移植的HSCT患者中进行了一项病例对照研究。病例有与CDI相符的临床表现且粪便样本艰难梭菌Xpert检测呈阳性。对照为CDI阴性，并在年龄、性别和移植类型上进行匹配。围移植期定义为自体造血干细胞移植（SCT）中干细胞动员操作前30天或移植后30天，或异基因SCT移植后90天。
在研究期间进行的781例HSCT中，650例（83.2%）提交了粪便样本进行CD检测。确定了86例（13.2%）CDI病例。大多数病例在移植后一周内确诊（中位时间为5天）。在多因素分析中，既往住院（比值比[OR]：2.01，95%置信区间[CI] 1.2 - 3.36）、既往使用头孢菌素（OR 2.72，95% CI：1.54 - 4.83）和既往化疗（OR：3.26，95% CI：1.92 - 5.5）与CDI显著相关。
住院以及既往使用抗生素和化疗是不易改变的危险因素，这强调了在这一高危人群中开始研究预防或预防性策略的必要性。
