Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA.
Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
J Evid Based Med. 2018 Feb;11(1):40-45. doi: 10.1111/jebm.12288. Epub 2018 Jan 11.
Clostridium difficile infection (CDI) is a major concern for public health worldwide. Interestingly, the risk of poor clinical outcomes of CDI in patients with nasogastric tube (NGT) insertion is still controversial. The aim of this study was to assess the outcomes of CDI in patients with NGT insertion.
A literature search was performed using MEDLINE, EMBASE, and The Cochrane Database of Systematic Reviews from inception through November 2017. Studies that reported relative risks, odds ratios, or hazard ratios comparing the clinical outcome of CDI in patients with NGT versus those who did not were included. Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method.
Eight observational studies were included in our analysis to assess the association between NGT insertion and risk of poor outcome of CDI. The pooled RR of severe or complicated clinical outcomes of CDI in patients with NGT insertion was 1.81 (95% CI: 1.17 to 2.81).
This study demonstrated a statistically significant association between NGT insertion and risk of poor outcomes of CDI. This finding may impact clinical management and primary prevention of CDI. Avoidance of unnecessary NGT uses would improve the clinical outcomes of CDI.
艰难梭菌感染（CDI）是全球公共卫生的主要关注点。有趣的是，有鼻胃管（NGT）插入的患者 CDI 不良临床结局的风险仍存在争议。本研究旨在评估有 NGT 插入的患者 CDI 的结局。
通过 MEDLINE、EMBASE 和 The Cochrane Database of Systematic Reviews 从建库至 2017 年 11 月进行文献检索。纳入报告了相对风险、比值比或风险比，以比较有 NGT 与无 NGT 患者 CDI 临床结局的研究。使用随机效应、通用倒数方差法计算汇总风险比（RR）和 95%置信区间（CI）。
有 8 项观察性研究纳入我们的分析，以评估 NGT 插入与 CDI 不良结局风险之间的关联。有 NGT 插入的患者严重或复杂 CDI 临床结局的汇总 RR 为 1.81（95%CI：1.17 至 2.81）。
本研究表明 NGT 插入与 CDI 不良结局风险之间存在统计学显著关联。这一发现可能影响 CDI 的临床管理和一级预防。避免不必要的 NGT 使用将改善 CDI 的临床结局。
