Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States of America.
Department of Pharmaceutical Outcomes and Policy, College of Pharmacy at the University of Florida, Gainesville, Florida, United States of America.
PLoS One. 2018 Dec 17;13(12):e0209152. doi: 10.1371/journal.pone.0209152. eCollection 2018.
Elderly patients and those with comorbid conditions are at high risk for poor outcomes after Clostridium difficile infection (CDI) but outcomes in a healthier, nonelderly population are not well described. We sought to investigate gastrointestinal diagnoses and CDI during hospitalizations in the 24 to 36 months after an initial episode of CDI in nonelderly patients in a cohort with an overall low prevalence of comorbid conditions. We performed a retrospective analysis of hospital admissions from 2010-2013 using the Truven MarketScan database of employment-based private insurance claims. Subjects <65 years of age and their adult dependents (> = 18 years old); a CDI diagnosis in 2011 (index date); at least 12 months of pre-index continuous enrollment; and 24-36 months of continuous post-index enrollment were included. The 12 months of each subject's enrollment prior to the index date for a CDI served as the reference period for the analyses of that subject's post-CDI time periods. Hospital claims during the follow-up period were evaluated for gastrointestinal diagnoses and/or CDI ICD-9 codes. The risk of gastrointestinal diagnoses was assessed using Cox proportional hazards models adjusted for a pre-specified set of baseline demographic and clinical factors. During 2011, 5,632 subjects with CDI met the inclusion criteria for our study. The risk of gastrointestinal diagnoses in patients with a CDI diagnostic code for the same admission was almost 8-fold higher 3 months post-CDI (hazard ratio (HR) = 7.56; 95% confidence interval (CI): 2.97-19.19) than for subjects without CDI and remained statistically significant until month 24 (HR = 1.47; 95% CI = 1.04-2.08). After CDI, patients remained at risk for gastrointestinal symptoms with CDI for up to two years. There is an important, long-term healthcare burden after CDI in this population.
老年患者和合并症患者在艰难梭菌感染 (CDI) 后预后不良的风险较高，但在健康的非老年人群中的结局尚未得到充分描述。我们旨在调查在初始 CDI 发作后 24 至 36 个月内，患有总体合并症患病率较低的队列中，非老年患者住院期间的胃肠道诊断和 CDI。我们使用 Truven MarketScan 基于就业的私人保险索赔数据库，对 2010-2013 年的住院记录进行了回顾性分析。纳入年龄 <65 岁的患者及其成年家属 (> = 18 岁)；2011 年诊断为 CDI（索引日期）；至少 12 个月的索引前连续入组；且 24-36 个月的连续索引后入组。每位患者 CDI 索引日期前的 12 个月的入组期作为其 CDI 后时间段分析的参考期。在随访期间，对胃肠道诊断和/或 CDI ICD-9 编码的住院记录进行评估。使用 Cox 比例风险模型评估胃肠道诊断风险，该模型根据一组预先指定的基线人口统计学和临床因素进行了调整。在 2011 年，有 5632 例 CDI 患者符合我们研究的纳入标准。在同一入院时诊断为 CDI 的患者中，CDI 诊断代码后 3 个月发生胃肠道诊断的风险高近 8 倍（风险比 (HR) = 7.56；95%置信区间 (CI)：2.97-19.19），而无 CDI 的患者则显著低于该风险（HR = 1.47；95% CI = 1.04-2.08），直到第 24 个月。CDI 后，患者仍有胃肠道症状的风险，最长可持续两年。在该人群中，CDI 后存在重要的长期医疗保健负担。
