Daida Atsuro, Yoshihara Hiroki, Inai Ikuko, Hasegawa Daisuke, Ishida Yasushi, Urayama Kevin Y, Manabe Atsushi
*Department of Pediatrics, St. Luke's International Hospital, Chuo-ku, Tokyo †Pediatric Medical Center, Ehime Prefectural Central Hospital, Matsuyama, Ehime ‡Center for Clinical Epidemiology §Research Center, St. Luke's International University, Chuo-ku, Tokyo, Japan.
J Pediatr Hematol Oncol. 2017 Apr;39(3):e167-e172. doi: 10.1097/MPH.0000000000000742.
Hospital-acquired Clostridium difficile infection (CDI) may cause life-threatening colitis for children with cancer, making identification of risk factors important. We described characteristics of pediatric cancer patients with primary and recurring CDI, and evaluated potential risk factors. Among 189 cancer patients, 51 cases (27%) of CDI and 94 matched controls of cancer patients without CDI were analyzed. Multivariable logistic regression was used to evaluate the association between CDI and several potential risk factors. Median age of CDI cases was lower (3.3 y; 0.60 to 16.2) than controls (7.7 y; 0.4 to 20.5). Median duration of neutropenia before CDI was longer for CDI cases (10.0 d; 0.0 to 30.0) compared with duration calculated from reference date in controls (6.0 d; 0.0 to 29.0). Multivariable analysis showed that older age was associated with reduced risk (≥7 vs. 0 to 3 y, odds ratio=0.11; 95% confidence interval, 0.02-0.54), and prolonged neutropenia was associated with increased risk (odds ratio=1.11; 95% confidence interval, 1.01-1.22). CDI recurred in 26% of cases. Younger age and prolonged neutropenia were risk factors for CDI in children with cancer. Increasing awareness to these risk factors will help to identify opportunities for CDI prevention in cancer patients.
医院获得性艰难梭菌感染（CDI）可能会给癌症患儿带来危及生命的结肠炎，因此识别风险因素很重要。我们描述了原发性和复发性CDI的儿科癌症患者的特征，并评估了潜在风险因素。在189名癌症患者中，分析了51例（27%）CDI病例和94名未患CDI的癌症患者匹配对照。采用多变量逻辑回归评估CDI与几种潜在风险因素之间的关联。CDI病例的中位年龄（3.3岁；0.60至16.2岁）低于对照组（7.7岁；0.4至20.5岁）。与根据对照组参考日期计算的持续时间（6.0天；0.0至29.0天）相比，CDI病例在CDI发生前的中性粒细胞减少中位持续时间更长（10.0天；0.0至30.0天）。多变量分析显示，年龄较大与风险降低相关（≥7岁与0至3岁相比，比值比=0.11；95%置信区间，0.02 - 0.54），而中性粒细胞减少持续时间延长与风险增加相关（比值比=1.11；95%置信区间，1.01 - 1.22）。26%的病例出现CDI复发。年龄较小和中性粒细胞减少持续时间延长是癌症患儿发生CDI的风险因素。提高对这些风险因素的认识将有助于识别癌症患者预防CDI的机会。
