Department of Infectious Diseases, St. Luke's International Hospital: 9-1, Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.
Graduate School of Public Health, St. Luke's International University: OMURA Susumu & Mieko Memorial St. Luke's Center for Clinical Academia, 5th Floor, 3-6-2, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
J Infect Chemother. 2022 Aug;28(8):1131-1137. doi: 10.1016/j.jiac.2022.04.011. Epub 2022 Apr 16.
Clostridioides difficile infection (CDI) is an important community- and hospital-acquired infection. Patients receiving tube feeding often have diarrhoea, and it is still unclear whether the traditional criteria for submitting samples for Clostridioides difficile (CD) testing as determined by the frequency of the diarrhoea apply to these patients.
We conducted a retrospective study comparing the clinical features of tube-fed inpatients with suspected CDI, with CDI, and those without CDI admitted between 2004 and 2020. Univariate associations were assessed using the chi-square test, Fisher's exact test, or student's t-test, and multivariate analysis was conducted using logistic regression analysis.
Among 805 tube-fed inpatients with and suspected CDI, 163 (20.2%) had CDI and 642 (79.8%) did not. The following seven predictors, independently associated with CDI, were used to develop the SEASON GAP score: male (Sex) (1 point), Emaciation (1 point), days from Admission to testing ≥21 days (2 points), Stool frequency/day ≥5 times (1 point), seasON (summer: 2 points, spring and winter: 1 point), GAstrostomy (2 points), and no prior Proton pump inhibitor use (1 point). In a receiver operating characteristic curve, the area under the curve was 0.77 (95% confidence interval: 0.73-0.80). The optimal cut-off point was 3.5. A score of ≤3 had a sensitivity, specificity, and negative predictive value of 81%, 60%, and 93%, respectively.
The SEASON GAP score is useful in ruling out CDI in patients with tube feeding, thus reducing unnecessary CD testing and antimicrobial use.
艰难梭菌感染（CDI）是一种重要的社区和医院获得性感染。接受管饲的患者常出现腹泻，目前仍不清楚是否应将传统的提交艰难梭菌（CD）检测样本的标准应用于这些患者，这些标准取决于腹泻的频率。
我们进行了一项回顾性研究，比较了 2004 年至 2020 年期间疑似 CDI、确诊 CDI 和无 CDI 的管饲住院患者的临床特征。使用卡方检验、Fisher 确切检验或学生 t 检验评估单变量关联，使用逻辑回归分析进行多变量分析。
在 805 例疑似和确诊 CDI 的管饲住院患者中，163 例（20.2%）患有 CDI，642 例（79.8%）未患有 CDI。以下七个预测因子与 CDI 独立相关，用于开发 SEASON GAP 评分：男性（Sex）（1 分）、消瘦（Emaciation）（1 分）、从入院到检测的天数≥21 天（2 分）、每日排便次数≥5 次（1 分）、季节（夏季：2 分，春季和冬季：1 分）、胃造口术（GAstrostomy）（2 分）和未使用质子泵抑制剂（1 分）。在受试者工作特征曲线中，曲线下面积为 0.77（95%置信区间：0.73-0.80）。最佳截断点为 3.5。得分≤3 时，敏感性、特异性和阴性预测值分别为 81%、60%和 93%。
SEASON GAP 评分有助于排除管饲患者的 CDI，从而减少不必要的 CD 检测和抗菌药物使用。
