Delgado Andrew, Reveles Ivan A, Cabello Felicia T, Reveles Kelly R
College of Pharmacy, The University of Texas at Austin, 2409 University Avenue, A1900, Austin, TX, 78712, USA.
Pharmacotherapy Education and Research Center, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, MC-6220, San Antonio, TX, 78229, USA.
BMC Infect Dis. 2017 Jun 23;17(1):448. doi: 10.1186/s12879-017-2553-z.
Cancer predisposes patients to Clostridium difficile infection (CDI) due to health care exposures and medications that disrupt the gut microbiota or reduce immune response. Despite this association, the national rate of CDI among cancer patients is unknown. Furthermore, it is unclear how CDI affects clinical outcomes in cancer. The objective of this study was to describe CDI incidence and health outcomes nationally among cancer patients in the United States (U.S.).
Data for this study were obtained from the U.S. National Hospital Discharge Surveys from 2001 to 2010. Eligible patients included those at least 18 years old with a discharge diagnosis of cancer (ICD-9-CM codes 140-165.X, 170-176.X, 179-189.X, 190-209.XX). CDI was identified using ICD-9-CM code 008.45. Data weights were applied to sampled patients to provide national estimates. CDI incidence was calculated as CDI discharges per 1000 total cancer discharges. The in-hospital mortality rate and hospital length of stay (LOS) were compared between cancer patients with and without CDI using bivariable analyses.
A total of 30,244,426 cancer discharges were included for analysis. The overall incidence of CDI was 8.6 per 1000 cancer discharges. CDI incidence increased over the study period, peaking in 2008 (17.2 per 1000 cancer discharges). Compared to patients without CDI, patients with CDI had significantly higher mortality (9.4% vs. 7.5%, p < 0.0001) and longer median LOS (9 days vs. 4 days, p < 0.0001).
CDI incidence is increasing nationally among cancer patients admitted to U.S. community hospitals. CDI was associated with significantly increased mortality and hospital LOS.
由于医疗保健暴露以及扰乱肠道微生物群或降低免疫反应的药物，癌症使患者易患艰难梭菌感染（CDI）。尽管存在这种关联，但癌症患者中CDI的全国发病率尚不清楚。此外，目前尚不清楚CDI如何影响癌症的临床结局。本研究的目的是描述美国癌症患者中CDI的发病率和健康结局。
本研究的数据来自2001年至2010年的美国国家医院出院调查。符合条件的患者包括年龄至少18岁且出院诊断为癌症的患者（ICD-9-CM编码140-165.X、170-176.X、179-189.X、190-209.XX）。使用ICD-9-CM编码008.45识别CDI。对抽样患者应用数据权重以提供全国估计值。CDI发病率计算为每1000例癌症出院患者中的CDI出院人数。使用双变量分析比较有和没有CDI的癌症患者的院内死亡率和住院时间（LOS）。
总共纳入30,244,426例癌症出院患者进行分析。CDI的总体发病率为每1000例癌症出院患者中有8.6例。在研究期间，CDI发病率有所上升，在2008年达到峰值（每1000例癌症出院患者中有17.2例）。与没有CDI的患者相比，患有CDI的患者死亡率显著更高（9.4%对7.5%，p<0.0001），中位LOS更长（9天对4天，p<0.0001）。
在美国社区医院收治的癌症患者中，CDI发病率在全国范围内呈上升趋势。CDI与死亡率和住院LOS显著增加相关。
