Carver College of Medicine, Department of Internal Medicine, University of Iowa, Iowa City.
Division of Medical Practice, Hospital Israelita Albert Einstein, São Paulo, Brazil.
JAMA Netw Open. 2020 Jan 3;3(1):e1917597. doi: 10.1001/jamanetworkopen.2019.17597.
An understanding of the incidence and outcomes of Clostridium difficile infection (CDI) in the United States can inform investments in prevention and treatment interventions.
To quantify the incidence of CDI and its associated hospital length of stay (LOS) in the United States using a systematic literature review and meta-analysis.
MEDLINE via Ovid, Cochrane Library Databases via Wiley, Cumulative Index of Nursing and Allied Health Complete via EBSCO Information Services, Scopus, and Web of Science were searched for studies published in the United States between 2000 and 2019 that evaluated CDI and its associated LOS.
Incidence data were collected only from multicenter studies that had at least 5 sites. The LOS studies were included only if they assessed postinfection LOS or used methods accounting for time to infection using a multistate model or compared propensity score-matched patients with CDI with control patients without CDI. Long-term-care facility studies were excluded. Of the 119 full-text articles, 86 studies (72.3%) met the selection criteria.
Two independent reviewers performed the data abstraction and quality assessment. Incidence data were pooled only when the denominators used the same units (eg, patient-days). These data were pooled by summing the number of hospital-onset CDI incident cases and the denominators across studies. Random-effects models were used to obtain pooled mean differences. Heterogeneity was assessed using the I2 value. Data analysis was performed in February 2019.
Incidence of CDI and CDI-associated hospital LOS in the United States.
When the 13 studies that evaluated incidence data in patient-days due to hospital-onset CDI were pooled, the CDI incidence rate was 8.3 cases per 10 000 patient-days. Among propensity score-matched studies (16 of 20 studies), the CDI-associated mean difference in LOS (in days) between patients with and without CDI varied from 3.0 days (95% CI, 1.44-4.63 days) to 21.6 days (95% CI, 19.29-23.90 days).
Pooled estimates from currently available literature suggest that CDI is associated with a large burden on the health care system. However, these estimates should be interpreted with caution because higher-quality studies should be completed to guide future evaluations of CDI prevention and treatment interventions.
了解美国艰难梭菌感染（CDI）的发病率和结局有助于为预防和治疗干预措施提供投资信息。
通过系统文献回顾和荟萃分析，量化美国 CDI 的发病率及其相关住院时间（LOS）。
通过 Ovid 检索 MEDLINE、通过 Wiley 检索 Cochrane 图书馆数据库、通过 EBSCO Information Services 检索 Cumulative Index of Nursing and Allied Health Complete、Scopus 和 Web of Science，检索在美国发表的评估 CDI 及其相关 LOS 的研究，检索时间为 2000 年至 2019 年。
仅收集来自至少有 5 个地点的多中心研究的发病率数据。只有在评估感染后 LOS 或使用多状态模型或比较 CDI 患者和无 CDI 对照患者的倾向评分匹配患者来计算感染时间的方法的 LOS 研究才被纳入。排除长期护理机构研究。在 119 篇全文文章中，有 86 篇研究（72.3%）符合入选标准。
两名独立审查员进行了数据提取和质量评估。仅当使用相同单位（例如，患者天数）的除数时，才对发病率数据进行汇总。通过汇总研究间的医院获得性 CDI 发病例数和除数，汇总这些数据。使用随机效应模型获得汇总平均差异。使用 I2 值评估异质性。数据分析于 2019 年 2 月进行。
美国 CDI 的发病率和 CDI 相关的医院 LOS。
当汇总 13 项评估因医院获得性 CDI 导致的患者日发病率数据的研究时，CDI 的发病率为每 10000 患者日 8.3 例。在倾向评分匹配的研究中（20 项研究中的 16 项），CDI 相关 LOS （以天为单位）的平均差异在有和无 CDI 的患者之间从 3.0 天（95%CI，1.44-4.63 天）到 21.6 天（95%CI，19.29-23.90 天）不等。
目前文献中的汇总估计表明，CDI 给医疗保健系统带来了巨大负担。然而，这些估计应谨慎解读，因为应完成更高质量的研究来指导未来对 CDI 预防和治疗干预措施的评估。
