复发性感染的发病率、危险因素及结局的前瞻性研究
Prospective Study on Incidence, Risk Factors and Outcome of Recurrent Infections.
作者信息
Granata Guido, Petrosillo Nicola, Adamoli Lucia, Bartoletti Michele, Bartoloni Alessandro, Basile Gregorio, Bassetti Matteo, Bonfanti Paolo, Borromeo Raffaella, Ceccarelli Giancarlo, De Luca Anna Maria, Di Bella Stefano, Fossati Sara, Franceschini Erica, Gentile Ivan, Giacobbe Daniele Roberto, Giacometti Enrica, Ingrassia Fabrizio, Lagi Filippo, Lobreglio Giambattista, Lombardi Andrea, Lupo Laura Isabella, Luzzati Roberto, Maraolo Alberto Enrico, Mikulska Malgorzata, Mondelli Mario Umberto, Mularoni Alessandra, Mussini Cristina, Oliva Alessandra, Pandolfo Alessandro, Rogati Carlotta, Trapani Filippo Fabio, Venditti Mario, Viale Pierluigi, Caraffa Emanuela, Cataldo Maria Adriana
机构信息
Clinical and Research Department for Infectious Diseases, National Institute for Infectious Diseases L. Spallanzani IRCCS, 00149 Rome, Italy.
Infectious Diseases ISMETT IRCCS, 90127 Palermo, Italy.
出版信息
J Clin Med. 2021 Mar 8;10(5):1127. doi: 10.3390/jcm10051127.
BACKGROUND
Limited and wide-ranging data are available on the recurrent infection (rCDI) incidence rate.
METHODS
We performed a cohort study with the aim to assess the incidence of and risk factors for rCDI. Adult patients with a first CDI, hospitalized in 15 Italian hospitals, were prospectively included and followed-up for 30 d after the end of antimicrobial treatment for their first CDI. A case-control study was performed to identify risk factors associated with 30-day onset rCDI.
RESULTS
Three hundred nine patients with a first CDI were included in the study; 32% of the CDI episodes (99/309) were severe/complicated; complete follow-up was available for 288 patients (19 died during the first CDI episode, and 2 were lost during follow-up). At the end of the study, the crude all-cause mortality rate was 10.7% (33 deaths/309 patients). Two hundred seventy-one patients completed the follow-up; rCDI occurred in 21% of patients (56/271) with an incidence rate of 72/10,000 patient-days. Logistic regression analysis identified exposure to cephalosporin as an independent risk factor associated with rCDI (RR: 1.7; 95% CI: 1.1-2.7, = 0.03).
CONCLUSION
Our study confirms the relevance of rCDI in terms of morbidity and mortality and provides a reliable estimation of its incidence.
背景
关于复发性艰难梭菌感染（rCDI）发病率的可用数据有限且范围广泛。
方法
我们进行了一项队列研究，旨在评估rCDI的发病率及危险因素。前瞻性纳入了在15家意大利医院住院的首次发生艰难梭菌感染（CDI）的成年患者，并在其首次CDI抗菌治疗结束后进行30天的随访。进行了一项病例对照研究以确定与30天内发生rCDI相关的危险因素。
结果
309例首次发生CDI的患者纳入研究；32%的CDI发作（99/309）为重度/复杂性发作；288例患者获得了完整随访（19例在首次CDI发作期间死亡，2例在随访期间失访）。研究结束时，全因粗死亡率为10.7%（33例死亡/309例患者）。271例患者完成随访；21%的患者（56/271）发生rCDI，发病率为72/10000患者日。逻辑回归分析确定使用头孢菌素是与rCDI相关的独立危险因素（相对危险度：1.7；95%可信区间：1.1 - 2.7，P = 0.03）。
结论
我们的研究证实了rCDI在发病率和死亡率方面的相关性，并提供了其发病率的可靠估计。
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