Scardina Tonya L, Kang Martinez Elena, Balasubramanian Neelam, Fox-Geiman Mary, Smith Scott E, Parada Jorge P
Department of Pharmacy, Loyola University Medical Center, Maywood, Illinois.
Midwestern University, Downers Grove, Illinois.
Pharmacotherapy. 2017 Apr;37(4):420-428. doi: 10.1002/phar.1914. Epub 2017 Mar 30.
The primary objective was to determine the impact of hematologic malignancies and/or conditioning regimens on the risk of developing Clostridium difficile infection (CDI) in patients undergoing hematopoietic stem cell transplantation (HSCT). Secondary objectives were to determine if traditional CDI risk factors applied to patients undergoing HSCT and to determine the presence of CDI markers of severity of illness among this patient population.
Single-center retrospective case-control study.
Quaternary care academic medical center.
A total of 105 patients who underwent HSCT between December 2009 and December 2014; of these patients, 35 developed an initial episode of CDI (HSCT/CDI group [cases]), and 70 did not (controls). Controls were matched in a 2:1 ratio to cases based on age (± 10 yrs) and date of HSCT (± 6 mo).
Baseline characteristics of the two groups were well balanced regarding age, sex, race, ethnicity, and type of HSCT. No significant differences in conditioning regimen, hematologic malignancy, total body irradiation received for HSCT, use of antibiotics within 60 days of HSCT, or use of prophylactic antibiotics after HSCT were noted between the two groups. Patients in the control group were 10.57 (95% confidence interval 1.24-492.75) more likely to have received corticosteroids prior to HSCT than patients in the HSCT/CDI group (p=0.01). Use of proton pump inhibitors at the time of HSCT was greater among the control group than among patients in the HSCT/CDI group (97% vs 86%, p=0.048). No significant difference in mortality was noted between the groups at 3, 6, and 12 months after HSCT. Metronidazole was frequently prescribed for patients in the HSCT/CDI group (34 patients [97%]). Severe CDI was not common among patients within the HSCT/CDI group (13 patients [37%]); vancomycin was infrequently prescribed for these patients ([31%] 4/13 patients).
Hematologic malignancies and a conditioning regimen administered for HSCT were not significant risk factors for the development of CDI after HSCT. Use of corticosteroids prior to HSCT and use of proton pump inhibitors at the time of HSCT were associated with a significantly decreased risk of CDI.
主要目的是确定血液系统恶性肿瘤和/或预处理方案对接受造血干细胞移植（HSCT）患者发生艰难梭菌感染（CDI）风险的影响。次要目的是确定传统的CDI危险因素是否适用于接受HSCT的患者，并确定该患者群体中CDI病情严重程度的标志物。
单中心回顾性病例对照研究。
四级医疗学术医学中心。
2009年12月至2014年12月期间共105例接受HSCT的患者；其中35例发生了首次CDI发作（HSCT/CDI组[病例]），70例未发生（对照组）。根据年龄（±10岁）和HSCT日期（±6个月），对照组与病例按2:1的比例匹配。
两组在年龄、性别、种族、民族和HSCT类型方面的基线特征平衡良好。两组在预处理方案、血液系统恶性肿瘤、HSCT接受的全身照射、HSCT后60天内使用抗生素或HSCT后使用预防性抗生素方面均未发现显著差异。对照组患者在HSCT前接受皮质类固醇治疗的可能性比HSCT/CDI组患者高10.57倍（95%置信区间1.24-492.75）（p=0.01）。HSCT时对照组使用质子泵抑制剂的比例高于HSCT/CDI组患者（97%对86%，p=0.048）。HSCT后3、6和12个月时，两组的死亡率无显著差异。HSCT/CDI组患者经常使用甲硝唑（34例患者[97%]）。HSCT/CDI组患者中严重CDI并不常见（13例患者[37%]）；这些患者很少使用万古霉素（[31%]4/13例患者）。
血液系统恶性肿瘤和用于HSCT的预处理方案不是HSCT后发生CDI的显著危险因素。HSCT前使用皮质类固醇和HSCT时使用质子泵抑制剂与CDI风险显著降低相关。
