Intermountain Acute Leukemia Program, LDS Hospital, Salt Lake City, UT.
Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT; Department of Medicine, Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT.
Am J Infect Control. 2019 Apr;47(4):394-399. doi: 10.1016/j.ajic.2018.09.027. Epub 2018 Nov 22.
The frequency, risk factors, and outcomes for Clostridioides difficile infection (CDI) in patients with newly diagnosed acute leukemia (AL) admitted for induction therapy are unclear.
We studied 509 consecutive patients with AL admitted between 2006 and 2017 and conducted a prospective C difficile surveillance and ribotyping analysis in a subset of these.
The incidence of CDI was 2.2/1,000 inpatient days during induction, and CDI was rare after discharge. CDI was highest in patients with acute myelogenous leukemia. A hospitalization shortly before admission and administration of a greater number of antibiotics increased the risk for CDI. No single class of antibiotics conveyed an increased risk. All cases were successfully treated, and CDI was not associated with an increase in length of stay, costs, or mortality. In a subgroup analysis, 16% of patients with acute myelogenous leukemia and 4% with other leukemia types were colonized on admission. Colonization was associated with a higher risk of CDI. Ribotyping of available isolates showed 27 different strain types with 014/020 and 027 being the most frequent.
The number of antibiotics administered are a major risk factor for CDI in patients with AL. However, CDI appears to have minimal clinical impact in this population.
新诊断为急性白血病（AL）并接受诱导治疗的患者中，艰难梭菌感染（CDI）的频率、危险因素和结局尚不清楚。
我们研究了 2006 年至 2017 年间连续收治的 509 例 AL 患者，并对其中一部分患者进行了前瞻性艰难梭菌监测和核糖体分型分析。
诱导治疗期间，CDI 的发病率为每 1000 个住院日 2.2 例，出院后 CDI 很少见。急性髓系白血病患者的 CDI 发生率最高。入院前的住院时间短和使用的抗生素数量增加会增加 CDI 的风险。没有任何一类抗生素会增加风险。所有病例均成功治疗，CDI 并未导致住院时间延长、费用增加或死亡率增加。在亚组分析中，16%的急性髓系白血病患者和 4%的其他类型白血病患者入院时定植。定植与 CDI 风险增加相关。可获得的分离株的核糖体分型显示有 27 种不同的菌株类型，其中 014/020 和 027 最为常见。
AL 患者使用的抗生素数量是 CDI 的主要危险因素。然而，CDI 似乎对该人群的临床影响极小。
