慢性胰腺炎合并艰难梭菌感染的风险和结局。

Risk and Outcomes of Clostridium difficile Infection With Chronic Pancreatitis.

机构信息

From the Department of Medicine, North Shore Medical Center, Salem.

Department of Medicine, Tufts University Medical School, Boston.

出版信息

Pancreas. 2019 Sep;48(8):1041-1049. doi: 10.1097/MPA.0000000000001380.

DOI:10.1097/MPA.0000000000001380

PMID:31404028

Abstract

OBJECTIVES

Chronic pancreatitis (CP) is associated with high rates of recurrent hospitalizations, which predisposes to Clostridium difficile infection (CDI). We investigate the burden of CDI in CP.

METHODS

We identified records of patients with CP from the Nationwide Inpatient Sample (NIS) 2012-2014 and estimated the impact of CDI on their outcomes. We calculated the adjusted odds ratio (AOR) of CP on having CDI (NIS 2014). From NIS 2007-2014, we plotted the trends of CDI and its interaction with CP.

RESULTS

From 2012 to 2014, 886 (2.72%) of the 32,614 CP patients had concomitant CDI, which was associated with poorer outcomes: acute kidney injury (AOR, 2.57 [95% confidence interval {CI}, 2.11-3.13]), length of stay (13.3 vs 7.4 days), and charges (US $127,496 vs US $72,767), but not mortality (AOR, 0.93 [95% CI, 0.28-3.05]). In 2014, CP was associated with an increased risk of CDI (crude odds ratio, 2.10 [95% CI, 1.95-2.26]), which persisted after multivariate adjustment (AOR, 2.03 [95% CI, 1.87-2.19]). From 2007 to 2014, the annual prevalence of CDI was 106.4 cases per 10,000 hospitalizations, increasing from 2007 (95.5/10,000) to 2014 (118.4/10,000), with a 3.7 times higher annual rate of increase among CP versus no-CP patients (13.4/10,000 vs 3.7/10,000 population/year).

CONCLUSIONS

Chronic pancreatitis patients have high burden of CDI and may benefit from CDI prophylaxis.

摘要

目的

慢性胰腺炎（CP）与高复发住院率相关，易发生艰难梭菌感染（CDI）。本研究旨在探讨 CP 患者 CDI 的患病负担。

方法

我们从 2012-2014 年全国住院患者样本（NIS）中确定 CP 患者记录，并评估 CDI 对其结局的影响。我们计算了 CP 患者发生 CDI 的调整比值比（AOR）（NIS 2014）。我们还从 2007-2014 年 NIS 数据中绘制了 CDI 及其与 CP 相互作用的趋势图。

结果

2012-2014 年，32614 例 CP 患者中有 886 例（2.72%）合并 CDI，其预后更差：急性肾损伤（AOR，2.57 [95%置信区间 {CI}，2.11-3.13]）、住院时间（13.3 天 vs 7.4 天）和费用（US $127,496 vs US $72,767），但死亡率无差异（AOR，0.93 [95% CI，0.28-3.05]）。2014 年，CP 与 CDI 风险增加相关（粗比值比，2.10 [95% CI，1.95-2.26]），多变量调整后仍持续存在（AOR，2.03 [95% CI，1.87-2.19]）。2007-2014 年，CDI 年患病率为每 10000 例住院患者 106.4 例，从 2007 年（95.5/10000）增加到 2014 年（118.4/10000），CP 患者的年增长率比非 CP 患者高 3.7 倍（13.4/10000 vs 3.7/10000 人口/年）。