Kistangari Gaurav, Lopez Rocio, Shen Bo
*Department of Hospital Medicine, Medicine Institute, The Cleveland Clinic Foundation, Cleveland, Ohio; †Department of Quantitative Health Sciences, Lerner Research Institute, The Cleveland Clinic Foundation, Cleveland, Ohio; and ‡Center for Inflammatory Bowel Diseases, The Cleveland Clinic Foundation, Cleveland, Ohio.
Inflamm Bowel Dis. 2017 Apr;23(4):661-671. doi: 10.1097/MIB.0000000000001057.
Clostridium difficile infection (CDI) in patients with the ileal pouch after proctocolectomy has been increasingly recognized. We sought to evaluate the frequency and risk factors of CDI in patients with the primary or secondary discharge diagnosis of pouchitis in the United States.
We reviewed the National Inpatient Sample of the Healthcare Cost and Utilization Project and identified patients admitted for pouchitis with underlying inflammatory bowel disease (IBD) or familial adenomatous polyposis (FAP), between 2010 and 2012. Cases with CDI were identified based on a concomitant primary or secondary discharge diagnosis for CDI. The frequency of CDI was estimated in patients with underlying IBD and FAP. Multivariable analysis was conducted to study the risk factors associated with CDI in those with pouchitis with underlying IBD.
A total of 3566 eligible patients with pouchitis were identified during the study period. Eighty-nine patients (2.5%) had CDI as a concomitant primary or secondary discharge diagnosis. CDI was identified in 2.6% (99.9% confidence interval [CI], 1.3-3.8) of pouchitis patients with underling IBD. None of the patients with pouchitis with underlying FAP were found to have CDI during the study period. Among pouchitis patients with underlying IBD, the presence of nonalcoholic fatty liver disease (odds ratio = 5.4; 95% CI, 1.5-19.9), obesity (odds ratio = 5.5; 95% CI, 1.4-21.4), or obstructive sleep apnea (odds ratio = 10.3; CI, 2.0-53.7) was associated with an increased risk of CDI.
It seems that CDI was limited to pouchitis with underlying IBD and rare in those with underlying FAP. Patients with nonalcoholic fatty liver disease, obesity, and obstructive sleep apnea are at an increased risk of C. difficile pouchitis among patients with IBD.
直肠结肠切除术后回肠储袋患者的艰难梭菌感染（CDI）已得到越来越多的认识。我们试图评估美国以储袋炎为主要或次要出院诊断的患者中CDI的发生率及危险因素。
我们回顾了医疗成本和利用项目的全国住院患者样本，并确定了2010年至2012年间因潜在炎症性肠病（IBD）或家族性腺瘤性息肉病（FAP）而入院治疗储袋炎的患者。根据CDI的主要或次要出院诊断确定CDI病例。估计患有潜在IBD和FAP的患者中CDI的发生率。对患有潜在IBD的储袋炎患者进行多变量分析以研究与CDI相关的危险因素。
在研究期间共确定了3566例符合条件的储袋炎患者。八十九例患者（2.5%）的主要或次要出院诊断为CDI。在患有潜在IBD的储袋炎患者中，2.6%（99.9%置信区间[CI]，1.3 - 3.8）被诊断为CDI。在研究期间，患有潜在FAP的储袋炎患者均未发现患有CDI。在患有潜在IBD的储袋炎患者中，非酒精性脂肪性肝病（比值比 = 5.4；95% CI，1.5 - 19.9）、肥胖（比值比 = 5.5；95% CI，1.4 - 21.4）或阻塞性睡眠呼吸暂停（比值比 = 10.3；CI，2.0 - 53.7）与CDI风险增加相关。
似乎CDI仅限于患有潜在IBD的储袋炎患者，而在患有潜在FAP的患者中罕见。在患有IBD的患者中，非酒精性脂肪性肝病、肥胖和阻塞性睡眠呼吸暂停患者发生艰难梭菌性储袋炎的风险增加。
