Intermountain Blood and Marrow Transplant Program, LDS Hospital, Salt Lake City, UT, USA.
Department of Medicine, Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT, USA.
Clin Transplant. 2019 Nov;33(11):e13712. doi: 10.1111/ctr.13712. Epub 2019 Nov 6.
More data are needed regarding the incidence, risk factors, and outcomes for Clostridioides difficile infection (CDI) and colonization in patients undergoing an autologous hematopoietic stem cell transplantation (AHSCT).
We studied 472 consecutive patients admitted for a first AHSCT and conducted a prospective C difficile stool surveillance and ribotyping analysis in a subset of 94 patients.
Clostridioides difficile infection was diagnosed in 7% of patients for an incidence of 3.4 CDI/1000 inpatient days, recurrent/reinfection CDI was rare. CDI was increased in patients who were colonized on admission, had required a recent pre-admission inpatient stay for fever and/or serious infection, or received empiric therapy with a carbapenem or extended-spectrum penicillin. CDI was associated with a longer length of stay and higher hospital costs. Twelve of 94 patients (13%) were found to have colonization on admission; CDI was diagnosed in 27% of these vs 1% in those with initial negative stools. Colonization in the hospital for those negative on admission was infrequent. C difficile ribotyping showed a predominance of 014/020.
Clostridioides difficile infection is a significant infection in patients receiving a first AHSCT. The risk factors identified may be useful in designing preventive interventions.
对于接受自体造血干细胞移植（AHSCT）的患者，我们需要更多关于艰难梭菌感染（CDI）和定植的发病率、危险因素和结果的数据。
我们研究了 472 例首次接受 AHSCT 的连续患者，并对 94 例患者进行了前瞻性艰难梭菌粪便监测和核糖体分型分析。
7%的患者诊断为 CDI，发病率为 3.4 CDI/1000 住院日，复发性/再感染 CDI 罕见。在入院时定植、最近因发热和/或严重感染而需要入院前住院治疗、或接受碳青霉烯类或广谱青霉素经验性治疗的患者中，CDI 更为常见。CDI 与住院时间延长和更高的住院费用相关。94 例患者中有 12 例（13%）入院时即存在定植，其中 27%的患者诊断为 CDI，而初始粪便阴性的患者为 1%。入院时粪便阴性的患者在医院定植的情况并不常见。艰难梭菌核糖体分型显示 014/020 占优势。
CDI 是接受首次 AHSCT 的患者的严重感染。确定的危险因素可能有助于设计预防干预措施。
