Department of Internal Medicine, Tainan Hospital, Ministry of Health and Welfare, Executive Yuan, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
J Microbiol Immunol Infect. 2021 Dec;54(6):1101-1110. doi: 10.1016/j.jmii.2021.02.002. Epub 2021 Feb 20.
Among the individuals with hematological malignancy (HM) complicated with Clostridioides difficile infection (CDI), the variables associated with in-hospital mortality and recurrence of CDI were investigated.
Including adults with HM and those without malignancy suffering from CDI from January 2015 to December 2016 in three hospitals in Taiwan.
Totally 314 patients including 77 with HM and 237 patients without malignancy were included. HM patients more often had low leukocyte counts (<500 cells/mL: 28.6% vs. 2.1%) than those without malignancy and more patients without malignancy had severe CDI than patients with HM (31.6% vs. 14.3%, P = .003), according to the severity score of IDSA/SHEA. Patients with HM had a higher recurrence rate of CDI (14.3%, 11/77 vs. 7.2%, 17/237; P = .07) and longer hospital stay (47.2 ± 40.8 days vs. 33.3 ± 37.3 days; P = .006) than those without malignancy. In the multivariate analyses for those with HM and CDI, the in-hospital mortality was associated with vancomycin-resistant Enterococcus (VRE) colonization or infection (odds ratio [OR] 7.72; P = .01), and C. difficile ribotype 078 complex infection (OR 9.22; P = .03). Moreover underlying hematological malignancy (OR 2.74; P = .04) and VRE colonization/infection (OR 2.71; P = .02) were independently associated with CDI recurrence.
Patients with HM complicated with CDI were often regarded as non-severe infection, but had a similar in-hospital mortality rate as those without malignancy. CDI due to ribotype 078 complex isolates heralded a poor prognosis among HM patients.
本研究旨在探讨血液病合并艰难梭菌感染（CDI）患者的住院死亡率和 CDI 复发的相关因素。
本研究纳入了 2015 年 1 月至 2016 年 12 月期间，台湾三家医院收治的血液病合并 CDI 患者（HM 组）和非恶性血液病合并 CDI 患者（非 HM 组）。
共纳入 314 例患者，其中 77 例为 HM 患者，237 例为非 HM 患者。HM 患者白细胞计数较低（<500 细胞/mL：28.6% vs. 2.1%）和发生严重 CDI 的比例（31.6% vs. 14.3%）均高于非 HM 患者（P=0.003，根据 IDSA/SHEA 严重程度评分）。HM 患者 CDI 复发率（14.3%，11/77 比 7.2%，17/237；P=0.07）和住院时间（47.2±40.8 天比 33.3±37.3 天；P=0.006）均长于非 HM 患者。在 HM 合并 CDI 患者的多因素分析中，住院死亡率与万古霉素耐药肠球菌（VRE）定植或感染（比值比 [OR] 7.72；P=0.01）和艰难梭菌 078 复合感染（OR 9.22；P=0.03）有关。此外，基础血液病（OR 2.74；P=0.04）和 VRE 定植/感染（OR 2.71；P=0.02）与 CDI 复发独立相关。
血液病合并 CDI 的患者常被认为是非严重感染，但住院死亡率与非恶性血液病合并 CDI 患者相似。艰难梭菌 078 复合感染患者预后较差。
