美国多重复发艰难梭菌感染发病率的增加：一项队列研究。
Increasing Incidence of Multiply Recurrent Clostridium difficile Infection in the United States: A Cohort Study.
机构信息
From University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
出版信息
Ann Intern Med. 2017 Aug 1;167(3):152-158. doi: 10.7326/M16-2733. Epub 2017 Jul 4.
BACKGROUND
Clostridium difficile infection (CDI), the most common health care-associated infection, often recurs. Fecal microbiota transplantation is increasingly used to treat multiply recurrent CDI (mrCDI).
OBJECTIVE
To determine whether the incidence of mrCDI is increasing in proportion to CDI and to identify risk factors for mrCDI.
DESIGN
Retrospective cohort study.
SETTING
United States.
PARTICIPANTS
38 911 718 commercially insured patients in the OptumInsight Clinformatics Database, of whom 45 341 developed CDI.
MEASUREMENTS
Age- and sex-standardized incidence rates for CDI and mrCDI.
RESULTS
From 2001 to 2012, the annual incidence of CDI and mrCDI per 1000 person-years increased by 42.7% (from 0.4408 to 0.6289 case) and 188.8% (from 0.0107 to 0.0309 case), respectively. The increase in mrCDI incidence was independent of known risk factors for CDI. Those who developed mrCDI were older (median age, 56.0 vs. 49.0 years; adjusted odds ratio [aOR] per 10-year increase in age, 1.25 [95% CI, 1.21 to 1.29]) and were more likely to be female (63.8% vs. 58.7%; aOR, 1.24 [CI, 1.11 to 1.38]) and to have used antibiotics (72.3% vs. 58.8%; aOR, 1.79 [CI, 1.59 to 2.01]), proton-pump inhibitors (24.6% vs. 18.2%; aOR, 1.14 [CI, 1.01 to 1.29]), or corticosteroids (18.3% vs. 13.7%; aOR, 1.15 [CI, 1.00 to 1.32]) within 90 days of CDI diagnosis. Chronic kidney disease (10.4% vs. 5.6%; aOR, 1.49 [CI, 1.24 to 1.80]) and diagnosis in a nursing home (2.1% vs. 0.6%; aOR, 1.99 [CI, 1.34 to 2.93]) were also associated with increased risk for mrCDI.
LIMITATION
The primary analyses included only commercially insured patients in the United States.
CONCLUSION
Relative to CDI, mrCDI incidence has disproportionately increased, indicating a rising demand for mrCDI therapies.
PRIMARY FUNDING SOURCE
National Institute of Diabetes and Digestive and Kidney Diseases and National Institute of Allergy and Infectious Diseases.
背景
艰难梭菌感染（CDI）是最常见的与医疗保健相关的感染，经常复发。粪便微生物群移植越来越多地用于治疗多重复发 CDI（mrCDI）。
目的
确定 mrCDI 的发病率是否与 CDI 成比例增加，并确定 mrCDI 的危险因素。
设计
回顾性队列研究。
地点
美国。
参与者
在 OptumInsight Clinformatics Database 中有 38911718 名商业保险患者患有 CDI，其中 45341 名患者患有 CDI。
测量
每 1000 人年 CDI 和 mrCDI 的年龄和性别标准化发病率。
结果
从 2001 年到 2012 年，每 1000 人年 CDI 和 mrCDI 的发病率分别增加了 42.7%（从 0.4408 增加到 0.6289 例）和 188.8%（从 0.0107 增加到 0.0309 例）。mrCDI 发病率的增加与 CDI 的已知危险因素无关。那些患有 mrCDI 的人年龄更大（中位数年龄为 56.0 岁，而 49.0 岁；每增加 10 岁的调整优势比 [aOR]，1.25 [95%CI，1.21 至 1.29]），更有可能是女性（63.8%，而 58.7%；aOR，1.24 [CI，1.11 至 1.38]），并且更有可能在 CDI 诊断后 90 天内使用抗生素（72.3%，而 58.8%；aOR，1.79 [CI，1.59 至 2.01]）、质子泵抑制剂（24.6%，而 18.2%；aOR，1.14 [CI，1.01 至 1.29]）或皮质类固醇（18.3%，而 13.7%；aOR，1.15 [CI，1.00 至 1.32]）。慢性肾脏病（10.4%，而 5.6%；aOR，1.49 [CI，1.24 至 1.80]）和在疗养院诊断（2.1%，而 0.6%；aOR，1.99 [CI，1.34 至 2.93]）也与增加 mrCDI 的风险相关。
局限性
主要分析仅包括美国的商业保险患者。
结论
与 CDI 相比，mrCDI 的发病率不成比例地增加，表明对 mrCDI 治疗的需求不断增加。
主要资金来源
美国国立糖尿病、消化和肾脏疾病研究所和美国国立过敏和传染病研究所。
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