Shah Kamini, Curtin Bryan F, Chu Christopher, Hwang Daniel, Flasar Mark H, von Rosenvinge Erik
Division of Infectious Diseases, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, United States.
Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 21201, United States.
World J Clin Oncol. 2017 Oct 10;8(5):398-404. doi: 10.5306/wjco.v8.i5.398.
To evaluate factors associated with infection (CDI) and outcomes of CDI in the myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) population.
After IRB approval, all MDS/AML patients hospitalized at the University of Maryland Greenebaum Comprehensive Cancer Center between August 2011 and December 2013 were identified. Medical charts were reviewed for demographics, clinical information, development of CDI, complications of CDI, and mortality. Patients with CDI, defined as having a positive stool PCR done for clinical suspicion of CDI, were compared to those without CDI in order to identify predictors of disease. A -test was used for comparison of continuous variables and chi-square or Fisher's exact tests were used for categorical variables, as appropriate.
Two hundred and twenty-three patients (60.1% male, mean age 61.3 years, 13% MDS, 87% AML) had 594 unique hospitalizations during the study period. Thirty-four patients (15.2%) were diagnosed with CDI. Factors significantly associated with CDI included lower albumin at time of hospitalization ( < 0.0001), prior diagnosis of CDI ( < 0.0001), receipt of cytarabine-based chemotherapy ( = 0.015), total days of neutropenia ( = 0.014), and total days of hospitalization ( = 0.005). Gender ( = 0.10), age ( = 0.77), proton-pump inhibitor use ( = 0.73), receipt of antibiotics ( = 0.66), and receipt of DNA hypomethylating agent-based chemotherapy ( = 0.92) were not significantly associated with CDI.
CDI is common in the MDS/AML population. Factors significantly associated with CDI in this population include low albumin, prior CDI, use of cytarabine-based chemotherapy, and prolonged neutropenia. In this study, we have identified a subset of patients in which prophylaxis studies could be targeted.
评估骨髓增生异常综合征（MDS）和急性髓系白血病（AML）患者中与艰难梭菌感染（CDI）相关的因素及CDI的结局。
经机构审查委员会（IRB）批准后，确定了2011年8月至2013年12月期间在马里兰大学格林ebaum综合癌症中心住院的所有MDS/AML患者。查阅病历以获取人口统计学、临床信息、CDI的发生情况、CDI的并发症及死亡率。将因临床怀疑CDI而粪便PCR检测呈阳性的CDI患者与无CDI的患者进行比较，以确定疾病的预测因素。连续变量采用t检验进行比较，分类变量则根据情况采用卡方检验或Fisher精确检验。
在研究期间，223例患者（60.1%为男性，平均年龄61.3岁，13%为MDS，87%为AML）有594次独立住院。34例患者（15.2%）被诊断为CDI。与CDI显著相关的因素包括住院时白蛋白水平较低（P<0.0001）、既往有CDI诊断（P<0.0001）、接受基于阿糖胞苷的化疗（P = 0.015）、中性粒细胞减少的总天数（P = 0.014）以及住院总天数（P = 0.005）。性别（P = 0.10）、年龄（P = 0.77）、质子泵抑制剂的使用（P = 0.73）、抗生素的使用（P = 0.66）以及接受基于DNA低甲基化剂的化疗（P = 0.92）与CDI无显著相关性。
CDI在MDS/AML患者中很常见。该人群中与CDI显著相关的因素包括低白蛋白、既往有CDI、使用基于阿糖胞苷的化疗以及长期中性粒细胞减少。在本研究中，我们确定了一部分可针对进行预防研究的患者亚组。
