Miller Reece, Heinlen Jonathan E
Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK.
Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK.
Urol Oncol. 2018 Dec;36(12):526.e7-526.e11. doi: 10.1016/j.urolonc.2018.08.011. Epub 2018 Sep 15.
Clostridium difficile infection (CDI) is an important cause of hospital acquired morbidity with implications for quality of care. Radical cystectomy is a surgical procedure associated with high rates of morbidity one of which is a high rate of CDI. The rate of CDI among patients undergoing radical cystectomy may be estimated based on the reports from single institutions or by querying national databases. This study aims to compare rates of CDI reported in single institution series with rates obtained from national datasets.
A search was conducted on PubMed and Google Scholar using the terms "cystectomy+difficile" and "cystectomy+complication." Three hundred fifty articles were screened and 46 met criteria for inclusion based on the presence of specific rates of C. difficile following radical cystectomy. In the case of articles reporting on the same database, only the article with a larger sample size was included in the pooled analysis. One study reviewing a single institution was excluded from pooled analysis because it did not relate the rate of CDI specifically with cystectomy. Multi-institutional studies were not included in pooled analysis.
After exclusion of repeated data and multi-institutional studies, the pooled analysis consisted of 39 studies. Thirty five articles reported rates of CDI in single institutions and 4 articles reported rates found in national databases. Studies focusing on a single institution reported an average 5.02% (standard deviation = 4.88) incidence of CDI, compared to an average of 1.92% (standard deviation = 0.22) in databases. The rate of CDI found by totaling patients and incidence of infection found that databases show a rate of 1.95%, while institutions show a rate of 4.11% (P < 0.0000001).
The rate of CDI following radical cystectomy may be underestimated in national databases. This has implications for the development of health policy and quality measures based on the rate of CDI.
艰难梭菌感染（CDI）是医院获得性发病的重要原因，对医疗质量有影响。根治性膀胱切除术是一种与高发病率相关的外科手术，其中之一就是CDI的高发病率。接受根治性膀胱切除术患者的CDI发病率可根据单一机构的报告或通过查询国家数据库来估计。本研究旨在比较单一机构系列报告的CDI发病率与从国家数据集获得的发病率。
在PubMed和谷歌学术上使用“膀胱切除术+艰难梭菌”和“膀胱切除术+并发症”进行搜索。筛选了350篇文章，46篇基于根治性膀胱切除术后艰难梭菌的特定发病率符合纳入标准。对于报告同一数据库的文章，仅将样本量较大的文章纳入汇总分析。一项回顾单一机构的研究被排除在汇总分析之外，因为它没有将CDI发病率与膀胱切除术具体关联起来。多机构研究未纳入汇总分析。
排除重复数据和多机构研究后，汇总分析包括39项研究。35篇文章报告了单一机构的CDI发病率，4篇文章报告了国家数据库中的发病率。专注于单一机构的研究报告CDI平均发病率为5.02%（标准差=4.88），而数据库中的平均发病率为1.92%（标准差=0.22）。通过汇总患者得出的CDI发病率与感染发生率显示，数据库显示的发病率为1.95%，而机构显示的发病率为4.11%（P<0.0000001）。
国家数据库中根治性膀胱切除术后的CDI发病率可能被低估。这对基于CDI发病率制定卫生政策和质量指标有影响。
