Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
J Natl Compr Canc Netw. 2017 Apr;15(4):466-472. doi: 10.6004/jnccn.2017.0046.
Patients with cancer have several risk factors for infection (CDI), but the impact of CDI on outcomes in this population needs elucidation. We analyzed the incidence of CDI and its impact on outcomes in patients with cancer using the National Hospital Discharge Survey (NHDS) database from 2001 to 2010. Diagnosis codes were used to identify patients with cancer and CDI events. Demographics, diagnoses, length of stay (LOS), and discharge information were abstracted. Multivariate linear and logistic regression models with weighted analysis were conducted to study CDI incidence and CDI-associated outcomes. Analyses were performed using SAS version 9.4. During the 10-year study period, 20.1 million discharges had a cancer diagnosis. CDI developed in 1.09% of patients with cancer versus 0.77% of patients without cancer (adjusted odds ratio [aOR], 1.28; 95% CI, 1.28-1.29; <.001). The incidence of CDI in patients with cancer increased during the 10-year study period (64.7 per 10,000 discharges in 2001-2002 to 109.1 in 2009-2010; <.001). In multivariable analysis, compared with patients with cancer without CDI, patients with cancer and CDI had a longer mean LOS (5.67 days; 95% CI, 5.39-5.94) and higher rates of in-hospital mortality (aOR, 1.18; 95% CI, 1.16-1.20) and discharge to a care facility (aOR, 1.74; 95% CI, 1.72-1.75; all <.001). In this national database, CDI incidence increased significantly in patients with cancer over the study period and was associated with prolonged hospitalization, increased mortality, and discharge to a care facility. Despite increased attention, CDI remained a serious infection and merits appropriate prevention and management.
患有癌症的患者存在多种感染（CDI）的风险因素，但 CDI 对该人群结局的影响仍需要阐明。我们利用 2001 年至 2010 年的全国医院出院调查（NHDS）数据库分析了癌症患者中 CDI 的发生率及其对结局的影响。采用诊断代码来识别癌症患者和 CDI 事件。提取患者的人口统计学、诊断、住院时间（LOS）和出院信息。采用加权分析的多变量线性和逻辑回归模型来研究 CDI 发生率和 CDI 相关结局。采用 SAS 版本 9.4 进行分析。在 10 年的研究期间，有 2010 万出院患者患有癌症。患有癌症的患者中 CDI 发生率为 1.09%，而无癌症的患者中为 0.77%（校正优势比 [aOR]，1.28；95%置信区间 [CI]，1.28-1.29；<0.001）。在 10 年的研究期间，癌症患者中 CDI 的发生率呈上升趋势（2001-2002 年为每 10000 出院患者 64.7 例，2009-2010 年为 109.1 例；<0.001）。在多变量分析中，与无 CDI 的癌症患者相比，患有癌症且合并 CDI 的患者 LOS 更长（平均 5.67 天；95%CI，5.39-5.94），院内死亡率更高（aOR，1.18；95%CI，1.16-1.20），且更倾向于出院至护理机构（aOR，1.74；95%CI，1.72-1.75；均<0.001）。在这个全国性数据库中，研究期间癌症患者的 CDI 发生率显著增加，与住院时间延长、死亡率增加和出院至护理机构相关。尽管受到了更多关注，但 CDI 仍是一种严重感染，需要进行适当的预防和管理。
