Clinical Epidemiology Program,Veterans Affairs Medical Center,White River Junction,Vermont.
Kaiser Permanente Center for Health Research,Portland,Oregon.
Infect Control Hosp Epidemiol. 2019 Sep;40(9):997-1005. doi: 10.1017/ice.2019.160. Epub 2019 Jul 19.
Clostridioides difficile infection (CDI) remains a significant public health concern, resulting in excess morbidity, mortality, and costs. Additional insight into the burden of CDI in adults aged <65 years is needed.
DESIGN/SETTING: A 6-year retrospective cohort study was conducted using data extracted from United States Veterans Health Administration electronic medical records.
PATIENTS/METHODS: Patients aged 18-64 years on January 1, 2011, were followed until incident CDI, death, loss-to-follow-up, or December 31, 2016. CDI was identified by a diagnosis code accompanied by metronidazole, vancomycin, or fidaxomicin therapy, or positive laboratory test. The clinical setting of CDI onset was defined according to 2017 SHEA-IDSA guidelines.
Of 1,073,900 patients, 10,534 had a CDI during follow-up. The overall incidence rate was 177 CDIs per 100,000 person years, rising steadily from 164 per 100,000 person years in 2011 to 189 per 100,000 person years in 2016. Those with a CDI were slightly older (55 vs 51 years) and sicker, with a higher baseline Charlson comorbidity index score (1.4 vs 0.5) than those without an infection. Nearly half (48%) of all incident CDIs were community associated, and this proportion rose from 41% in 2011 to 56% in 2016.
The findings from this large retrospective study indicate that CDI incidence, driven primarily by increasing community-associated infection, is rising among young and middle-aged adult Veterans with high service-related disability. The increasing burden of community associated CDI in this vulnerable population warrants attention. Future studies quantifying the economic and societal burden of CDI will inform decisions surrounding prevention strategies.
艰难梭菌感染（CDI）仍然是一个重大的公共卫生问题，导致发病率、死亡率和医疗费用增加。需要进一步了解 65 岁以下成年人 CDI 的负担。
设计/设置：一项为期 6 年的回顾性队列研究，使用从美国退伍军人健康管理局电子病历中提取的数据进行。
患者/方法：2011 年 1 月 1 日年龄在 18-64 岁的患者，随访至发生 CDI、死亡、失访或 2016 年 12 月 31 日。CDI 通过诊断代码伴有甲硝唑、万古霉素或非达霉素治疗或阳性实验室检查来识别。根据 2017 年 SHEA-IDSA 指南，CDI 发病的临床环境定义为。
在 1073900 名患者中，10534 例在随访期间发生 CDI。总发病率为每 100000 人年 177 例 CDI，从 2011 年的每 100000 人年 164 例稳步上升至 2016 年的每 100000 人年 189 例。感染患者年龄稍大（55 岁比 51 岁），病情更重，基线 Charlson 合并症指数评分更高（1.4 比 0.5）。所有新发 CDI 中近一半（48%）为社区相关，这一比例从 2011 年的 41%上升到 2016 年的 56%。
这项大型回顾性研究的结果表明，CDI 发病率主要由社区相关感染增加驱动，在高服务相关残疾的年轻和中年退伍军人中呈上升趋势。在这一脆弱人群中，社区相关 CDI 的负担不断增加值得关注。未来量化 CDI 的经济和社会负担的研究将为预防策略的决策提供信息。
