Gastroenterology Department, Reina Sofía University Hospital, Córdoba, Spain.
Maimónides Institute of Biomedical Research (IMIBIC), University of Córdoba, Córdoba, Spain.
Scand J Gastroenterol. 2023 Mar;58(3):232-239. doi: 10.1080/00365521.2022.2121175. Epub 2022 Sep 8.
Patients with ulcerative colitis (UC) are at increased risk of infection (CDI), which is the principal causative agent of nosocomial diarrhoea in western countries. This has been related to complications such as need of colectomy and mortality among these patients. The aim of this study was to assess the incidence and impact of CDI in patients hospitalised with UC.
Case-control retrospective study including patients admitted due to a UC flare from January 2000 to September 2018. Porpensity score matching (PSM) was performed to minimise selection bias taking into account the small number of cases compared to controls.
339 patients were included; CDI in 35 (10.3%) patients. After PSM, 35 (33.33%) cases and 70 (66.67%) controls were analysed. Patients with CDI presented higher rates of readmission (52.9% vs. 21.4%, = .001), increased mortality within the first 3 months post-discharge (5.9% vs. 0%, = .042) and increased need of therapy intensification in the first year after admission (20.7% vs. 12.5%, = .001). No risk factors for CDI were identified. Multivariable cox regression showed that treatment with 5-aminosalycilates at baseline (HR 0.42, 95% CI 0.18-0.92) and albumin <3.5 g/dL (HR 3.11, 95% CI 1.21-8.03) were associated with worse outcomes.
CDI is a prevalent situation in hospitalised UC patients related to higher mortality within the first 3 months after the infection, need for therapy intensification within the first year and readmission. Our results underline the importance of CDI detection in patients with a flare of UC.
溃疡性结肠炎（UC）患者感染（CDI）的风险增加，CDI 是西方国家医院性腹泻的主要病原体。这与这些患者需要结肠切除术和死亡等并发症有关。本研究旨在评估住院 UC 患者中 CDI 的发生率和影响。
回顾性病例对照研究，纳入 2000 年 1 月至 2018 年 9 月因 UC 发作入院的患者。考虑到病例数与对照组相比较少，采用倾向评分匹配（PSM）以最小化选择偏倚。
共纳入 339 例患者；35 例（10.3%）患者发生 CDI。PSM 后，分析了 35 例（33.33%）病例和 70 例（66.67%）对照。发生 CDI 的患者再入院率更高（52.9%比 21.4%，=0.001），出院后 3 个月内死亡率更高（5.9%比 0%，=0.042），入院后第一年强化治疗需求更高（20.7%比 12.5%，=0.001）。未发现 CDI 的危险因素。多变量 Cox 回归显示，基线时使用 5-氨基水杨酸（HR 0.42，95%CI 0.18-0.92）和白蛋白<3.5g/dL（HR 3.11，95%CI 1.21-8.03）与较差的预后相关。
CDI 在住院 UC 患者中较为普遍，与感染后 3 个月内死亡率较高、感染后第一年强化治疗需求增加和再入院有关。我们的研究结果强调了在 UC 发作患者中检测 CDI 的重要性。
