MacKenzie Erica L, Murillo Cynthia, Bartlett Allison H, Marrs Rachel, Landon Emily M, Ridgway Jessica P
Department of Medicine, Section of Infectious Diseases & Global Health, The University of Chicago Medicine, Chicago, Illinois.
Department of Infection Control and Prevention, The University of Chicago Medicine, Chicago, Illinois.
Infect Control Hosp Epidemiol. 2023 Nov;44(11):1782-1787. doi: 10.1017/ice.2022.240. Epub 2023 Jan 20.
To determine risk factors for colonization and infection (CDI) among patients admitted to the intensive care unit (ICU).
Retrospective observational cohort study.
Tertiary-care facility.
All adult patients admitted to an ICU from July 1, 2015, to November 6, 2019, who were tested for colonization. Patients with CDI were excluded.
Information was collected on patient demographics, comorbidities, laboratory results, and prescriptions. We defined colonization as a positive nucleic acid amplification test for up to 48 hours before or 24 hours after intensive care unit (ICU) admission without evidence of active infection. We defined active infection as the receipt of an antibiotic whose only indication is the treatment of CDI. The primary outcome measure was the development of CDI up to 30 days after ICU admission. Logistic regression was used to model associations between clinical variables and the development of CDI.
The overall colonization rate was 4% and the overall CDI rate was 2%. Risk factors for the development of CDI included colonization (aOR, 13.3; 95% CI, 8.3-21.3; < .0001), increased ICU length of stay (aOR, 1.04; 95% CI, 1.03-1.05; < .0001), and a history of inflammatory bowel disease (aOR, 3.8; 95% CI, 1.3-11.1; = .02). Receipt of any antibiotic during the ICU stay was associated with a borderline increased odds of CDI (aOR, 1.9; 95% CI, 1.0-3.4; = .05).
colonization is associated with the development of CDI among ICU patients.
确定重症监护病房（ICU）患者中艰难梭菌定植和感染（CDI）的危险因素。
回顾性观察队列研究。
三级医疗设施。
2015年7月1日至2019年11月6日入住ICU且接受定植检测的所有成年患者。排除患有CDI的患者。
收集患者人口统计学、合并症、实验室检查结果和处方信息。我们将定植定义为在重症监护病房（ICU）入院前至多48小时或入院后24小时内核酸扩增检测呈阳性，且无活动性感染证据。我们将活动性感染定义为接受仅用于治疗CDI的抗生素。主要结局指标是ICU入院后30天内CDI的发生情况。采用逻辑回归对临床变量与CDI发生之间的关联进行建模。
总体定植率为4%，总体CDI率为2%。CDI发生的危险因素包括定植（调整后比值比[aOR]，13.3；95%置信区间[CI]，8.3 - 21.3；P <.0001）、ICU住院时间延长（aOR，1.04；95% CI，1.03 - 1.05；P <.0001）以及炎症性肠病病史（aOR，3.8；95% CI，1.3 - 11.1；P =.02）。在ICU住院期间接受任何抗生素治疗与CDI发生几率略有增加相关（aOR，1.9；95% CI，1.0 - 3.4；P =.05）。
定植与ICU患者CDI的发生相关。
