比较感染艰难梭菌 106 型和其他产毒株的住院患者的临床结局评估。
Comparative clinical outcomes evaluation of hospitalized patients infected with Clostridioides difficile ribotype 106 vs. other toxigenic strains.
机构信息
Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX, USA; Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim, Saudi Arabia.
Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX, USA.
出版信息
Anaerobe. 2021 Dec;72:102440. doi: 10.1016/j.anaerobe.2021.102440. Epub 2021 Aug 27.
BACKGROUND
Although Clostridioides difficile surveillance often identifies emerging strains, clinical outcome evaluations are rarely performed. Ribotype (RT) 106 is a commonly isolated C. difficile strain worldwide; however, studies investigating RT 106 clinical outcomes are limited. The purpose of this study was to investigate clinical outcomes of RT 106 infections compared with two other endemic strains of varying virulence.
METHODS
This multicenter study evaluated adults hospitalized with C. difficile infection (CDI). C. difficile samples underwent PCR ribotyping and patients infected with RT 106 were compared to patients infected with a known hypervirulent strain (RT 027) and a strain associated with less virulence (RT 014-020). Electronic medical records were reviewed by blinded investigators to assess the primary outcome of poor clinical outcome (composite of initial clinical failure, discharge to a higher level of care, 90-day CDI recurrence, and CDI-contributable mortality).
RESULTS
A total of 396 patients with CDI were identified (RT 106, 32.3%; RT 027, 29.3%; RT 014-020, 38.3%). Patients infected with RT 014-020 less often experienced a poor clinical outcome (40%) compared with RT 106 (56%) and RT 027 (65%) infection (P < 0.0001). After controlling for covariates and using RT 014-020 as a comparator, patients infected with RT 106 (OR, 2.25; 95% CI, 1.36-3.73) or RT 027 (OR, 2.56; 95% CI, 1.52-4.31) had higher odds of poor clinical outcome. Using RT 027 as the comparator, only RT 014-020 was associated with lower odds of poor clinical outcome (OR, 0.42; 95% CI, 0.27-0.65).
CONCLUSION
This study demonstrated that the emergent C. difficile RT 106 was associated with increased rates of poor clinical outcomes compared to RT 014-020 and comparable poor clinical outcomes to RT 027. These findings can help to better understand the clinical significance of this and future emerging ribotypes.
背景
虽然艰难梭菌监测通常可以识别新出现的菌株，但很少进行临床结果评估。核糖体型（RT）106 是一种在全球范围内常见的艰难梭菌菌株；然而，关于 RT 106 临床结果的研究有限。本研究旨在调查与两种不同毒力的其他地方性菌株相比，RT 106 感染的临床结果。
方法
这项多中心研究评估了因艰难梭菌感染（CDI）住院的成年人。对艰难梭菌样本进行 PCR 核糖体型检测，将感染 RT 106 的患者与感染已知高毒力菌株（RT 027）和与较低毒力相关的菌株（RT 014-020）的患者进行比较。通过盲法调查人员审查电子病历，以评估不良临床结局的主要结局（初始临床失败、转至更高级别护理、90 天 CDI 复发和 CDI 相关死亡率的复合结局）。
结果
共确定了 396 例 CDI 患者（RT 106，32.3%；RT 027，29.3%；RT 014-020，38.3%）。与 RT 106（56%）和 RT 027（65%）感染相比，感染 RT 014-020 的患者不良临床结局（40%）发生率较低（P<0.0001）。在控制了协变量并将 RT 014-020 作为对照后，感染 RT 106（OR，2.25；95%CI，1.36-3.73）或 RT 027（OR，2.56；95%CI，1.52-4.31）的患者发生不良临床结局的可能性更高。以 RT 027 为对照，只有 RT 014-020 与不良临床结局的可能性较低相关（OR，0.42；95%CI，0.27-0.65）。
结论
本研究表明，与 RT 014-020 相比，新兴的艰难梭菌 RT 106 与不良临床结局发生率增加相关，与 RT 027 的不良临床结局相当。这些发现有助于更好地了解这种和未来新兴核糖体型的临床意义。
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