Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Gastroenterology and Hepatology Service, Sengkang General Hospital, Singapore.
J Gastroenterol Hepatol. 2021 Jan;36(1):89-104. doi: 10.1111/jgh.15102. Epub 2020 Jun 26.
Clostridiodes difficile infection (CDI) is one of the most common hospital-acquired infections with high mortality rates. Optimal management of CDI depends on early recognition of severity. However, currently, there is no acceptable standard of prediction. We reviewed severe CDI predictors in published literature and its definition according to clinical guidelines. We systematically reviewed studies describing clinical predictors for severe CDI in medical databases (Cochrane, EMBASE, Global Health Library, and MEDLINE/PubMed). They were independently evaluated by two reviewers. Six hundred thirty-three titles and abstracts were screened, and 31 studies were included. We excluded studies that were restricted to a specific patient population. There were 16 articles that examined mortality in CDI, as compared with 15 articles investigating non-mortality outcomes of CDI. The commonest risk factors identified were comorbidities, white blood cell count, serum albumin level, age, serum creatinine level and intensive care unit admission. Generally, the studies had small patient populations, were retrospective in nature, and mostly from Western centers. The commonest severe CDI criteria in clinical guidelines were raised white blood cell count, followed by low serum albumin and raised serum creatinine levels. There was no commonly agreed upon definition of severe CDI severity in the literature. Current clinical guidelines' definitions for severe CDI are heterogeneous. Hence, there is a need for prospective multi-center studies using standardized protocol for biospecimen investigation collection and shared data on outcomes of patients in order to devise a universally accepted definition for severe CDI.
艰难梭菌感染（CDI）是最常见的医院获得性感染之一，死亡率很高。CDI 的最佳治疗取决于早期识别严重程度。然而，目前还没有可接受的预测标准。我们回顾了已发表文献中严重 CDI 的预测因素及其根据临床指南的定义。我们系统地检索了描述医学数据库（Cochrane、EMBASE、全球健康图书馆和 MEDLINE/PubMed）中严重 CDI 临床预测因素的研究。这些研究由两名评审员独立评估。筛选了 633 个标题和摘要，最终纳入了 31 项研究。我们排除了仅限于特定患者人群的研究。有 16 篇文章研究了 CDI 中的死亡率，而 15 篇文章则研究了 CDI 的非死亡率结果。确定的最常见危险因素包括合并症、白细胞计数、血清白蛋白水平、年龄、血清肌酐水平和重症监护病房入院。一般来说，这些研究的患者人群较小，具有回顾性，且主要来自西方中心。临床指南中最常见的严重 CDI 标准是白细胞计数升高，其次是血清白蛋白和血清肌酐水平升高。文献中没有关于严重 CDI 严重程度的普遍共识定义。目前临床指南中严重 CDI 的定义存在差异。因此，需要使用标准化方案进行生物标本研究收集，并共享患者结局数据的前瞻性多中心研究，以便为严重 CDI 制定一个普遍接受的定义。
