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造血干细胞移植患者感染管理策略的单中心经验及文献综述

A Single-Center Experience and Literature Review of Management Strategies for Infection in Hematopoietic Stem Cell Transplant Patients.

作者信息

Majeed Aneela, Larriva Marti M, Iftikhar Ahmad, Mushtaq Adeela, Campbell Patrick, Nadeem Malik Mustafa, Rafae Abdul, Zar Muhammad Abu, Kamal Ahmad, Lakhani Midhat, Khalid Nageena Rani, Zangeneh Tirdad T, Anwer Faiz

机构信息

Department of Medicine, Division of Infectious Diseases, Stanford University, Stanford, CA.

Department of Pharmacy, University of Arizona, Tucson, AZ.

出版信息

Infect Dis Clin Pract (Baltim Md). 2020 Jan;28(1):10-15. doi: 10.1097/ipc.0000000000000798.

Abstract

INTRODUCTION

The aim of our study is to evaluate risk factors associated with the development of infection (CDI) in hematopoietic stem cell transplant (HSCT) patients, determine its incidence and report outcomes of CDI in our patient population.

METHODS

We performed a retrospective review of medical records of adult HSCT recipients diagnosed between 2013 and 2016 at our center. Logistic regression models were used to determine the relationship between risk factors and the odds of CDI.

RESULTS

The overall incidence of CDI in HSCT patients was 9.4%. The incidence of CDI was higher in allogeneic HSCT (20%) versus autologous HSCT (4.8%). No statistically significant differences in age, gender, cancer type, transplant type were found between those who developed CDI and those who did not. However, patients with CDI had a longer length of stay (25 days) and used more antibiotics (30 days prior to and during admission for HSCT) than non-CDI patients (19 days). Only two of 17 patients (11.8%) with CDI experienced recurrence among 180 patients after HSCT. No patient suffered from toxic megacolon or ileus and no patient underwent colectomy. There was no mortality associated with CDI at our center.

CONCLUSION

CDI has an incidence rate of 9.4% in HSCT recipients. Established risk factors including age, gender, cancer type, and transplant type were not identified as risk factors in our population. However, longer LOS and use of greater than four lines of antibiotics were observed among those with CDI compared to those without CDI.

摘要

引言

我们研究的目的是评估造血干细胞移植(HSCT)患者发生艰难梭菌感染(CDI)的相关危险因素,确定其发病率并报告我们患者群体中CDI的结局。

方法

我们对2013年至2016年在本中心诊断的成年HSCT受者的病历进行了回顾性研究。采用逻辑回归模型确定危险因素与CDI发生几率之间的关系。

结果

HSCT患者中CDI的总体发病率为9.4%。异基因HSCT(20%)中CDI的发病率高于自体HSCT(4.8%)。发生CDI的患者与未发生CDI的患者在年龄、性别、癌症类型、移植类型方面未发现统计学上的显著差异。然而,CDI患者的住院时间更长(25天),且在HSCT入院前及住院期间使用的抗生素更多(30天),而非CDI患者为19天。17例CDI患者中只有2例(11.8%)在HSCT后的180例患者中出现复发。没有患者发生中毒性巨结肠或肠梗阻,也没有患者接受结肠切除术。在我们中心,CDI未导致死亡。

结论

HSCT受者中CDI的发病率为9.4%。年龄、性别、癌症类型和移植类型等既定危险因素在我们的人群中未被确定为危险因素。然而,与未发生CDI的患者相比,发生CDI的患者住院时间更长,且使用了超过四种抗生素。

相似文献

本文引用的文献

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Clostridium difficile Infection in Special High-Risk Populations.特殊高危人群中的艰难梭菌感染。
Infect Dis Ther. 2016 Sep;5(3):253-69. doi: 10.1007/s40121-016-0124-z. Epub 2016 Aug 11.

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