重症监护病房艰难梭菌感染的临床特征和结局：KASID 多中心研究。

Clinical characteristics and outcomes of Clostridioides difficile infection in the intensive care unit: a KASID multi-centre study.

机构信息

Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea.

出版信息

J Hosp Infect. 2023 Sep;139:106-112. doi: 10.1016/j.jhin.2023.07.002. Epub 2023 Jul 12.

DOI:10.1016/j.jhin.2023.07.002

PMID:37451405

Abstract

BACKGROUND

Despite the growing clinical and economic burden of Clostridioides difficile infection (CDI), data on CDI in the intensive care unit (ICU) in the Asia-Pacific region are lacking.

METHODS

This retrospective study analysed 191 patients who were treated with CDI in the ICUs of three hospitals in South Korea from January 2017 to May 2021. Backward-stepwise multiple logistic regression was used to identify factors influencing the treatment response and mortality.

RESULTS

Fifty-eight patients (30.4%) were considered immunocompromised. The mean Charlson comorbidity index was 5.65 ± 2.39 (10-year survival rate: 21%), the APACHE II score was 20.86 ± 7.78 (mortality rate: 40%), the ATLAS score was 5.45 ± 1.59 (cure rate: 75%), and the SOFA score was 7.97 ± 4.03 (mortality rate: 21.5%). Fifty-eight (30.4%) of the CDI cases were severe and 40 (20.9%) were fulminant. Oral vancomycin or oral metronidazole was the most frequently first-line treatments (N = 57; 32.6%). The 10-day response rate was 59.7% and the eight-week overall mortality rate was 41.4%. Fulminant CDI (OR 0.230; 95% CI 0.085-0.623) and each one-unit increment in the SOFA score (OR 0.848; 95% CI 0.759-0.947) were associated with treatment failure. High APACHE II (OR 0.355; 95% CI 0.143-0.880) and SOFA (OR 0.164; 95% CI 0.061-0.441) scores were associated with higher mortality.

CONCLUSIONS

High-risk patients in the ICU had a higher mortality rate and a lower cure rate of CDI. Further research is required to provide more accurate prediction scoring systems and better clinical outcomes.

摘要

背景

尽管艰难梭菌感染（CDI）的临床和经济负担日益加重，但亚太地区重症监护病房（ICU）中 CDI 的数据仍很缺乏。

方法

本回顾性研究分析了 2017 年 1 月至 2021 年 5 月韩国 3 家医院 ICU 中治疗的 191 例 CDI 患者。采用后退逐步多因素逻辑回归分析确定影响治疗反应和死亡率的因素。

结果

58 例（30.4%）患者被认为免疫功能低下。Charlson 合并症指数的平均值为 5.65±2.39（10 年生存率：21%），急性生理和慢性健康状况评分系统 II（APACHE II）评分为 20.86±7.78（死亡率：40%），ATLAS 评分为 5.45±1.59（治愈率：75%），序贯器官衰竭评估（SOFA）评分为 7.97±4.03（死亡率：21.5%）。58 例（30.4%）CDI 患者为严重感染，40 例（20.9%）为暴发性感染。口服万古霉素或甲硝唑是最常用的一线治疗药物（N=57；32.6%）。10 天的治疗反应率为 59.7%，8 周的总死亡率为 41.4%。暴发性 CDI（OR 0.230；95%CI 0.085-0.623）和 SOFA 评分每增加 1 分（OR 0.848；95%CI 0.759-0.947）与治疗失败相关。APACHE II 评分高（OR 0.355；95%CI 0.143-0.880）和 SOFA 评分高（OR 0.164；95%CI 0.061-0.441）与更高的死亡率相关。