Patel I, Wungjiranirun M, Theethira T, Villafuerte-Galvez J, Castillo N, Akbari M, Alonso C D, Leffler D A, Kelly C P
Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA
J Antimicrob Chemother. 2017 Feb;72(2):574-581. doi: 10.1093/jac/dkw423. Epub 2016 Nov 14.
The objective of this study was to determine our institution's compliance with 2010 Society for Healthcare Epidemiology of America and IDSA Clostridium difficile infection (CDI) treatment guidelines and their respective outcomes.
We collected clinical parameters, laboratory values, antibiotic therapy and clinical outcomes from the electronic medical records for all patients hospitalized at our institution with a diagnosis of CDI from December 2012 to November 2013. We specifically evaluated whether SHEA-IDSA treatment guidelines were followed and evaluated the associations between guideline adherence and severe outcomes including mortality.
We identified 230 patients with CDI meeting inclusion criteria during the study period. Of these, 124 (54%) were appropriately treated, 46 (20%) were under-treated and 60 (26%) were over-treated. All-cause 90 day mortality was 17.4% overall; 43.5% in the under-treated group versus 12.9% in those appropriately treated (P < 0.0001) and 10.9% in those appropriately treated plus over-treated (P < 0.0001). Similarly, 90 day mortality attributed to CDI was 21.7% in those under-treated versus 8.9% in those appropriately treated (P = 0.03) and 8.2% in those either appropriately treated or over-treated (P = 0.015). Severe-complicated CDI occurred in 46 patients. In this subgroup, there was a non-significant trend towards increased mortality in under-treated patients (56.7%) compared with appropriately treated patients (37.5%, P = 0.35). Under-treatment was also associated with a higher rate of CDI-related ICU transfer (17.4% versus 4.8% in those appropriately treated, P = 0.023).
Adherence to CDI treatment guidelines is associated with improved outcomes especially in those with severe disease. Increased emphasis on provision of appropriate, guideline-based CDI treatment appears warranted.
本研究的目的是确定我们机构对2010年美国医疗保健流行病学学会和美国感染病学会艰难梭菌感染（CDI）治疗指南的遵循情况及其各自的结果。
我们从2012年12月至2013年11月在我们机构住院且诊断为CDI的所有患者的电子病历中收集临床参数、实验室值、抗生素治疗和临床结果。我们特别评估了是否遵循了美国医疗保健流行病学学会-美国感染病学会治疗指南，并评估了指南遵循情况与包括死亡率在内的严重后果之间的关联。
在研究期间，我们确定了230例符合纳入标准的CDI患者。其中，124例（54%）得到了适当治疗，46例（20%）治疗不足，60例（26%）治疗过度。总体全因90天死亡率为17.4%；治疗不足组为43.5%，而适当治疗组为12.9%（P<0.0001），适当治疗加治疗过度组为10.9%（P<0.0001）。同样，治疗不足的患者中因CDI导致的90天死亡率为21.7%，而适当治疗的患者为8.9%（P=0.03），适当治疗或治疗过度的患者为8.2%（P=0.015）。46例患者发生了严重复杂的CDI。在这个亚组中，治疗不足的患者（56.7%）与适当治疗的患者（37.5%，P=0.35）相比，死亡率有增加的趋势但无统计学意义。治疗不足还与更高的CDI相关重症监护病房（ICU）转诊率相关（17.4%比适当治疗的患者中的4.8%，P=
