社区获得性感染不良预后的危险因素。
Risk factors for poor outcome in community-onset infection.
机构信息
1Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 beon-gil, Bundang-gu, Seongnam, 463-707 Republic of Korea.
2Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
出版信息
Antimicrob Resist Infect Control. 2018 Jun 15;7:75. doi: 10.1186/s13756-018-0365-6. eCollection 2018.
BACKGROUND
A substantial portion of infection (CDI) cases occur in communities, and community-onset CDI (CO-CDI) can lead to serious complications including mortality. This study aimed to identify the risk factors for a poor outcome in CO-CDI.
METHODS
We performed a retrospective review of all inpatients with CDI, in a 1300-bed tertiary-care hospital in Korea, from 2008 through 2015. CO-CDI was defined as CDI occurring within 48 h of admission. Poor outcome was defined as follows: 1) all-cause 30-day mortality, 2) in-hospital mortality, or 3) surgery due to CDI.
RESULTS
Of a total 1256 CDIs occurring over 8 years, 152 (12.1%) cases were classified as CO-CDI and 23 (15.1%) had a poor outcome, including 22 (14.5%) cases of mortality and 2 (1.3%) cases of surgery. Patients with a poor outcome had a higher mean age than those without a poor outcome (75.8 vs. 69.6 years, = 0.03). The proportion of men and prior proton pump inhibitor (PPI) use were significantly higher in the poor outcome group (65.2% vs. 41.9%, = 0.04; 39.1% vs. 17.6%, = 0.02, respectively). Multivariate binary logistic model showed that PPI use and anemia (hemoglobin < 10 g/dL) at presentation were significantly associated with a poor outcome (adjusted odds ratio [aOR], 3.76; 95% confidence interval [95CI], 1.26-11.21, aOR, 4.67; 95CI, 1.52-14.34, respectively).
CONCLUSIONS
Clinicians should not only be aware of the possibility of CDI in the community setting but also pay more attention to PPI-using elderly patients with anemia in consideration of a poor outcome.
背景
大量的感染（CDI）病例发生在社区，社区获得性 CDI（CO-CDI）可导致严重并发症，包括死亡率。本研究旨在确定 CO-CDI 不良预后的危险因素。
方法
我们对韩国一家拥有 1300 张床位的三级保健医院 2008 年至 2015 年期间所有 CDI 住院患者进行了回顾性分析。CO-CDI 定义为入院 48 小时内发生的 CDI。不良预后定义如下：1）全因 30 天死亡率，2）住院死亡率，或 3）因 CDI 而行手术。
结果
在 8 年期间共发生了 1256 例 CDI，其中 152 例（12.1%）被归类为 CO-CDI，23 例（15.1%）有不良预后，包括 22 例（14.5%）死亡病例和 2 例（1.3%）手术病例。有不良预后的患者平均年龄高于无不良预后的患者（75.8 岁 vs. 69.6 岁， = 0.03）。男性和既往使用质子泵抑制剂（PPI）的比例在不良预后组中显著更高（65.2% vs. 41.9%， = 0.04；39.1% vs. 17.6%， = 0.02）。多变量二项逻辑模型显示，PPI 使用和入院时贫血（血红蛋白 <10 g/dL）与不良预后显著相关（调整后的优势比 [aOR]，3.76；95%置信区间 [95CI]，1.26-11.21，aOR，4.67；95CI，1.52-14.34）。
结论
临床医生不仅要意识到社区环境中 CDI 的可能性，还要注意使用质子泵抑制剂的老年贫血患者，以考虑不良预后。
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