027 型与再感染的观察性队列研究。

An Observational Cohort Study of Ribotype 027 and Recurrent Infection.

机构信息

Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA

Division of Infectious Diseases, University of Michigan, Ann Arbor, Michigan, USA.

出版信息

mSphere. 2018 May 23;3(3). doi: 10.1128/mSphere.00033-18. eCollection 2018 May-Jun.

Abstract

Recurrent infection (rCDI) frequently complicates recovery from CDI. Accurately predicting rCDI would allow judicious allocation of limited resources, but published models have met with limited success. Thus, biomarkers predictive of recurrence have been sought. This study tested whether PCR ribotype independently predicted rCDI. Stool samples from nonpregnant inpatients ≥18 years of age with diarrhea were included from October 2010 to January 2013 after the patients tested positive for in the clinical microbiology laboratory. Per guidelines, the rCDI was defined as a positive test for at >2 weeks but ≤8 weeks from the index episode. For each sample, a single colony of was isolated by anaerobic culture, confirmed to be toxigenic by PCR, and ribotyped. Simple logistic regression and multiple logistic regression were used to model the primary outcome of rCDI, incorporating a wide range of clinical parameters. In total, 927 patients with 968 index episodes of CDI were included, with 110 (11.4%) developing rCDI. Age and use of proton pump inhibitors or concurrent antibiotics did not increase the risk of rCDI. Low serum bilirubin levels and ribotype 027 were associated with increased risk of rCDI on unadjusted analysis, with health care-associated CDI being inversely associated. In the final multivariable model, ribotype 027 was the strongest independent predictor of rCDI (odds ratio, 2.17; 95% confidence interval, 1.33 to 3.56; = 0.002). Ribotype 027 is an independent predictor of rCDI. CDI is a major public health issue, with over 400,000 cases per year in the United States alone. Recurrent CDI is common, occurring in approximately one in five individuals after a primary episode. Although interventions exist that could reduce the risk of recurrence, deployment in all patients is limited by cost, invasiveness, and/or an undetermined long-term safety profile. Thus, clinicians need risk stratification tools to properly allocate treatments. Because prior research on clinical predictors has failed to yield a reliable, reproducible, and effective predictive model to assist treatment decisions, accurate biomarkers of recurrence would be of great value. This study tested whether PCR ribotype independently predicted rCDI, and the data build upon prior research in showing that ribotype 027 is associated with rCDI.

摘要

复发性感染(rCDI)常使 CDI 康复复杂化。准确预测 rCDI 将有助于合理分配有限的资源,但已发表的模型成功有限。因此,一直在寻找预测复发的生物标志物。这项研究测试了聚合酶链反应(PCR)核糖型是否能独立预测 rCDI。从 2010 年 10 月到 2013 年 1 月,从临床微生物学实验室检测到 阳性的≥18 岁住院非孕妇患者的粪便样本被纳入研究。根据指南,rCDI 的定义为在指数发作后>2 周但≤8 周时 阳性检测。对于每个样本,通过厌氧培养分离单个 单菌落,通过 PCR 确认产毒,并进行核糖型分析。简单逻辑回归和多变量逻辑回归用于对 rCDI 的主要结局进行建模,纳入了广泛的临床参数。共有 927 例患者发生 968 例 CDI 指数发作,其中 110 例(11.4%)发生 rCDI。年龄、质子泵抑制剂的使用或同时使用抗生素并未增加 rCDI 的风险。未调整分析时,血清胆红素水平低和核糖型 027 与 rCDI 风险增加相关,而与医疗保健相关的 CDI 则呈负相关。在最终的多变量模型中,核糖型 027 是 rCDI 的最强独立预测因子(比值比,2.17;95%置信区间,1.33 至 3.56;P=0.002)。核糖型 027 是 rCDI 的独立预测因子。CDI 是一个主要的公共卫生问题,仅在美国每年就有超过 40 万例。复发性 CDI 很常见,在首次发作后,大约每五名患者中就有一名发生。尽管存在可以降低复发风险的干预措施,但由于成本、侵袭性和/或不确定的长期安全性,并非所有患者都能实施这些措施。因此,临床医生需要风险分层工具来正确分配治疗。由于先前关于临床预测因子的研究未能提供可靠、可重复和有效的预测模型来协助治疗决策,因此准确的复发生物标志物将具有巨大价值。本研究测试了聚合酶链反应(PCR)核糖型是否能独立预测 rCDI,并且数据建立在先前研究的基础上,表明核糖型 027 与 rCDI 相关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b087/5967198/4cf91ab77599/sph0031825520001.jpg

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