Department of Pharmacy, Military Medical Academy, Belgrade, Serbia
Medical Faculty University of Defence, Belgrade, Serbia.
Eur J Hosp Pharm. 2022 Mar;29(e1):e15-e22. doi: 10.1136/ejhpharm-2020-002574. Epub 2021 Feb 12.
infection (CDI) is one of the most common healthcare-associated (HA) infections. Cancer patients, particularly haemato-oncological patients, have an increased risk for CDI due to more risk factors compared with non-cancer patients. The aim of this study was to investigate differences in outcomes associated with HA CDI in patients with solid and haematological malignancies compared with patients with no underlying malignant disease in a tertiary healthcare centre in Serbia.
A prospective cohort study was conducted including adult patients diagnosed with an initial episode of HA CDI. Their demographic and clinical characteristics associated with risk factors for CDI were documented. Outcomes such as all-cause 30-day mortality, cure of infection, diarrhoea relaps and recurrence of disease were followed. Patients were assigned to cancer and non-cancer groups. Within the cancer group, patients were divided into the solid tumour subgroup and haematological malignancy subgroup.
During a 7-year period, HA CDI was observed in 28 (5.1%) patients with haematological malignancy, 101 (18.3%) patients with solid tumours and 424 (76.7%) non-cancer patients. Older age (OR 1.04, 95% CI 1.02 to 1.07, p<0.001), admission to the intensive care unit (ICU) (OR 2.61, 95% CI 1.37 to 4.95, p=0.003), mechanical ventilation (OR 5.19, 95% CI 2.78 to 9.71, p<0.001) and use of antibiotics prior to CDI (OR 1.04, 95% CI 1.02 to 1.06, p=0.02) were associated with increased mortality. Compared with patients with solid tumours, patients with haematological malignancy were younger (65 vs 57 years, p=0.015), did not require ICU admission (25.0% vs 0%) or mechanical ventilation (8.9% vs 0%) and were treated longer with antibiotics prior to CDI (14 vs 24 days, p=0.002).
Patients with haematological malignancy were exposed to different risk factors for CDI associated with mortality compared with patients with solid tumours and non-cancer patients. Older age, ICU stay and mechanical ventilation, but not presence or type of cancer, predicted the all-cause 30-day mortality.
感染（CDI）是最常见的与医疗保健相关的（HA）感染之一。与非癌症患者相比，癌症患者，尤其是血液肿瘤患者，由于存在更多的风险因素，因此患 CDI 的风险更高。本研究的目的是在塞尔维亚的一家三级医疗中心，调查与实体和血液恶性肿瘤患者相比，HA CDI 相关的HA CDI 患者的结局差异。
进行了一项前瞻性队列研究，包括诊断为首次 HA CDI 的成年患者。记录了与 CDI 风险因素相关的患者的人口统计学和临床特征。随访了包括所有原因 30 天死亡率、感染治愈、腹泻复发和疾病复发在内的结局。患者被分配到癌症和非癌症组。在癌症组中，患者分为实体瘤亚组和血液恶性肿瘤亚组。
在 7 年期间，血液恶性肿瘤患者中有 28 例（5.1%）、实体瘤患者中有 101 例（18.3%）和非癌症患者中有 424 例（76.7%）出现 HA CDI。年龄较大（OR 1.04，95%CI 1.02 至 1.07，p<0.001）、入住重症监护病房（ICU）（OR 2.61，95%CI 1.37 至 4.95，p=0.003）、机械通气（OR 5.19，95%CI 2.78 至 9.71，p<0.001）和 CDI 前使用抗生素（OR 1.04，95%CI 1.02 至 1.06，p=0.02）与死亡率增加相关。与实体瘤患者相比，血液恶性肿瘤患者更年轻（65 岁与 57 岁，p=0.015）、无需入住 ICU（25.0%与 0%）或机械通气（8.9%与 0%），并且在 CDI 前接受抗生素治疗的时间更长（14 天与 24 天，p=0.002）。
与实体瘤患者和非癌症患者相比，血液恶性肿瘤患者发生 CDI 的风险因素不同，这与死亡率相关。年龄较大、入住 ICU 和机械通气，但不是癌症的存在或类型，预测了所有原因的 30 天死亡率。
