2007 - 2013年脓毒性休克患者艰难梭菌感染的全国趋势：对预后的影响

National Trends (2007-2013) of Clostridium difficile Infection in Patients with Septic Shock: Impact on Outcome.

作者信息

Chatterjee Kshitij, Goyal Abhinav, Chada Aditya, Kakkera Krishna Siva, Corwin Howard L

机构信息

Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.

Department of Internal Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA.

出版信息

J Hosp Med. 2017 Sep;12(9):717-722. doi: 10.12788/jhm.2816.

DOI:10.12788/jhm.2816

PMID:28914275

Abstract

BACKGROUND

Clostridium difficile is the most common infectious cause of healthcare-associated diarrhea and is associated with worse outcomes and higher cost. Patients with septic shock (SS) are at increased risk of acquiring C. difficile infections (CDIs) during hospitalization, but little data are available on CDI complicating SS.

OBJECTIVE

Prevalence of CDI in SS between 2007-2013 and impact of CDI on outcomes in SS.

METHODS

Outcomes were prevalence of CDI in SS, effect on mortality, length of stay (LOS), and 30-day readmission.

RESULTS

There were 2,031,739 hospitalizations with SS (2007-2013). CDI was present in 8.2% of SS. The in-hospital mortality of SS with and without CDI were comparable (37.1% vs 37.0%; 𝑃 = 0.48). Median LOS was longer for SS with CDI (13 days vs 9 days; 𝑃 < 0.001). LOS >75th percentile (>17 days) was 36.9% in SS with CDI vs 22.7% without CDI (𝑃 < 0.001). Similarly, LOS > 90th percentile (> 29 days) was 17.5% vs 9.1%, 𝑃 < 0.001. Odds of LOS >75% and >90% in SS were greater with CDI (odds ratio [OR] 2.11; 95% confidence interval [CI], 2.06-2.15; 𝑃 < 0.001 and OR 2.25; 95% CI, 2.22-2.28; 𝑃 < 0.001, respectively). Hospital readmission of SS with CDI was increased, adjusted OR 1.26 (95% CI, 1.22-1.31; 𝑃 < 0.001).

CONCLUSIONS

CDI complicating SS is common and is associated with increased hospital LOS and 30-day hospital readmission. This represents a population in which a focus on prevention and treatment may improve clinical outcomes.

摘要

背景

艰难梭菌是医疗保健相关腹泻最常见的感染病因，且与更差的预后和更高的成本相关。感染性休克（SS）患者在住院期间感染艰难梭菌的风险增加，但关于SS合并艰难梭菌感染（CDI）的数据很少。

目的

2007年至2013年间SS患者中CDI的患病率以及CDI对SS患者预后的影响。

方法

观察指标为SS患者中CDI的患病率、对死亡率、住院时间（LOS）和30天再入院率的影响。

结果

2007年至2013年期间，有2,031,739例SS患者住院。8.2%的SS患者存在CDI。合并CDI和未合并CDI的SS患者的院内死亡率相当（37.1%对37.0%；P = 0.48）。合并CDI的SS患者的中位LOS更长（13天对9天；P < 0.001）。合并CDI的SS患者中LOS>第75百分位数（>17天）的比例为36.9%，未合并CDI的为22.7%（P < 0.001）。同样，LOS>第90百分位数（>29天）的比例分别为17.5%对9.1%，P < 0.001。合并CDI的SS患者LOS>75%和>90%的几率更高（优势比[OR] 为2.11；95%置信区间[CI]，2.06 - 2.15；P < 0.001和OR 2.25；95% CI，2.22 - 2.28；P < 0.001）。合并CDI的SS患者的医院再入院率增加，校正后的OR为1.26（95% CI，1.22 - 1.31；P < 0.001）。