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住院和门诊儿科肿瘤和造血干细胞移植患者艰难梭菌感染的流行病学和临床特征。

Epidemiologic and Clinical Characteristics of Clostridioides difficile Infections in Hospitalized and Outpatient Pediatric Oncology and Hematopoietic Stem Cell Transplant Patients.

机构信息

Department of Pathology.

Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee.

出版信息

Pediatr Infect Dis J. 2021 Jul 1;40(7):655-662. doi: 10.1097/INF.0000000000003126.

Abstract

BACKGROUND

The epidemiology and clinical course of Clostridioides difficile infection (CDI) in children, especially with cancer, are poorly defined. We aim to describe the epidemiology, clinical features and outcomes of CDI and to identify risk factors for recurrence in a pediatric oncology center.

METHODS

This is a retrospective cohort study of CDI in pediatric oncology and hematopoietic stem cell transplant (HSCT) patients in 2016 and 2017. CDI cases were identified by positive C. difficile test in symptomatic patients. CDI episodes were classified as incident, duplicate or recurrent and community-onset, hospital-onset or community-onset healthcare facility-associated. Data about clinical course and outcomes were abstracted. Risk factors for CDI recurrence were assessed by logistic regression.

RESULTS

One hundred seventy-eight patients 1 year of age and older developed 291 CDI episodes; 78% were incident and 22% recurrent. Underlying diagnoses were leukemia/lymphoma (57%) and solid/brain tumors (41%); 30% were HSCT recipients. Antibiotics, chemotherapy, antacids, steroids and laxatives were received by 96%, 82%, 70%, 47% and 15%, respectively. Half of the patients were neutropenic. Twenty-two percent of outpatients with CDI required hospitalization. Chemotherapy was delayed in 25%. There were no intensive care unit admissions nor deaths due to CDI. Exposure to H2-antagonists was identified as an independent risk factor for CDI recurrence.

CONCLUSIONS

Although CDI in pediatric oncology and HSCT patients was associated with chemotherapy delay and hospitalization in approximately a quarter of patients, it was not associated with morbidity or mortality because patients had no attributable intensive care unit admission nor death. H2-antagonists are independent risk factors for CDI recurrence.

摘要

背景

艰难梭菌感染(CDI)在儿童中的流行病学和临床过程,尤其是癌症患儿,尚不清楚。我们旨在描述儿科肿瘤中心 CDI 的流行病学、临床特征和结局,并确定复发的危险因素。

方法

这是 2016 年和 2017 年对儿科肿瘤学和造血干细胞移植(HSCT)患者中 CDI 的回顾性队列研究。在有症状的患者中通过阳性艰难梭菌检测来识别 CDI 病例。将 CDI 发作分为新发、重复或复发以及社区发病、医院发病或社区发病医疗机构相关。提取有关临床过程和结局的数据。通过逻辑回归评估 CDI 复发的危险因素。

结果

178 名年龄在 1 岁及以上的患者发生了 291 次 CDI 发作;78%为新发,22%为复发。基础诊断为白血病/淋巴瘤(57%)和实体瘤/脑肿瘤(41%);30%为 HSCT 受者。96%、82%、70%、47%和 15%的患者分别接受了抗生素、化疗、抗酸剂、类固醇和泻药。一半的患者中性粒细胞减少。22%的门诊 CDI 患者需要住院治疗。25%的患者化疗延迟。没有因 CDI 而入住重症监护病房或死亡的病例。暴露于 H2 拮抗剂被确定为 CDI 复发的独立危险因素。

结论

尽管儿科肿瘤学和 HSCT 患者中的 CDI 与大约四分之一患者的化疗延迟和住院治疗相关,但由于患者没有因 CDI 而发生可归因的重症监护病房入院或死亡,因此它与发病率或死亡率无关。H2 拮抗剂是 CDI 复发的独立危险因素。

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