University of Mississippi School of Pharmacy, Department of Pharmacy Practice, 2500 N. State Street, Jackson, MS 39216, USA.
University of Mississippi School of Pharmacy, Department of Pharmacy Practice, 2500 N. State Street, Jackson, MS 39216, USA; University of Mississippi Medical Center, Division of Infectious Diseases, 2500 N. State Street, Jackson, MS 39216, USA.
J Glob Antimicrob Resist. 2021 Jun;25:18-22. doi: 10.1016/j.jgar.2021.02.012. Epub 2021 Mar 2.
The purpose of this study was to identify risk factors for initial complicated Clostridioides difficile infection (CDI).
This retrospective cross-sectional study included adult patients with initial episodes of CDI who received ≥72 h of CDI-active antimicrobials. Patients were categorised into one of two groups: complicated CDI or uncomplicated CDI. A total of 513 patients were screened for inclusion, with complicated CDI patients exhibiting abnormal abdominal CT findings or experiencing death within 30 days post-CDI diagnosis.
A total of 203 patients met the inclusion criteria, comprising 143 (70.4%) with uncomplicated CDI and 60 (29.6%) with complicated CDI. Complicated CDI patients were more likely to have been exposed to fluoroquinolones (48.3% vs. 30.8%; P = 0.017) and to carbapenems for a longer duration prior to CDI diagnosis (7 days vs. 3 days; P = 0.019). They were more likely to receive oral vancomycin (65.0% vs. 46.9%; P = 0.018) and rectal vancomycin (5.0% vs. 0%; P = 0.025) compared with uncomplicated CDI patients. Logistic regression identified previous fluoroquinolone exposure increased the risk of complicated CDI, while previous abdominal surgery decreased the risk.
Almost one-third of included patients experienced a complicated episode of CDI as their initial episode. Further research is warranted to elucidate the extent of influence of prior antibiotics on the development of complicated CDI.
本研究旨在确定初次复杂艰难梭菌感染（CDI）的危险因素。
本回顾性横断面研究纳入了接受≥72 小时 CDI 活性抗菌药物治疗的初发 CDI 成年患者。患者分为两组：复杂 CDI 或不复杂 CDI。共筛选了 513 名患者，复杂 CDI 患者的腹部 CT 检查结果异常或在 CDI 诊断后 30 天内死亡。
共有 203 名患者符合纳入标准，其中 143 名（70.4%）为不复杂 CDI，60 名（29.6%）为复杂 CDI。复杂 CDI 患者更有可能接触过氟喹诺酮类药物（48.3%比 30.8%；P=0.017）和更长时间的碳青霉烯类药物治疗（7 天比 3 天；P=0.019）。与不复杂 CDI 患者相比，他们更有可能接受口服万古霉素（65.0%比 46.9%；P=0.018）和直肠万古霉素（5.0%比 0%；P=0.025）。逻辑回归确定，先前氟喹诺酮类药物暴露增加了复杂 CDI 的风险，而先前的腹部手术降低了风险。
近三分之一的纳入患者经历了初次复杂 CDI 发作。需要进一步研究阐明先前抗生素对复杂 CDI 发展的影响程度。
