Department of Internal Medicine, Ospedale Fornaroli, ASST Ovest Milanese, Magenta, MI, Italy.
Department of Internal Medicine, Ospedale di Circolo and Fondazione Macchi, ASST Sette Laghi, Varese, Italy.
Intern Emerg Med. 2023 Oct;18(7):2003-2009. doi: 10.1007/s11739-023-03395-5. Epub 2023 Aug 26.
Medical divisions are at high risk of Clostridioides difficile infection (CDI) due to patients' frailty and complexity. This sub-analysis of the FADOI-PRACTICE study included patients presenting with diarrhea either at admission or during hospitalization. CDI diagnosis was confirmed when both enzyme immunoassay and A and B toxin detection were found positive. The aim of this sub-analysis was the identification of a new score to predict CDI in hospitalized, medical patients. Five hundred and seventy-two patients with diarrhea were considered. More than half of patients was female, 40% on antibiotics in the previous 4 weeks and 60% on proton pump inhibitors (PPIs). CDI diagnosis occurred in 103 patients (18%). Patients diagnosed with CDI were older, more frequently of female sex, recently hospitalized and bed-ridden, and treated with antibiotics and PPIs. Through a backward stepwise logistic regression model, age > 65 years, female sex, recent hospitalization, recent antibiotic therapy, active cancer, prolonged hospital stay (> 12 days), hypoalbuminemia (albumin < 3 g/dL), and leukocytosis (white blood cells > 9 × 10^9/L) were found to independently predict CDI occurrence. These variables contributed to building a clinical prognostic score with a good sensitivity and a modest specificity for a value > 3 (79% and 58%, respectively; AUC 0.75, 95% CI 0.71-0.79, p < 0.001), that identified low-risk (score ≤ 3; 42.5%) and high-risk (score > 3; 57.5%) patients. Although some classical risk factors were confirmed to increase CDI occurrence, the changing landscape of CDI epidemiology suggests a reappraisal of common risk factors and the development of novel risk scores based on local epidemiology.
由于患者的脆弱性和复杂性，医学科系存在高风险的艰难梭菌感染（CDI）。本项 FADOI-PRACTICE 研究的亚分析纳入了以腹泻为表现且于入院时或住院期间发生腹泻的患者。当酶联免疫吸附试验和 A 和 B 毒素检测均呈阳性时，可确诊 CDI。本亚分析的目的是确定一种新的评分来预测住院的医学科系患者的 CDI。共纳入了 572 例腹泻患者。超过一半的患者为女性，40%的患者在过去 4 周内使用了抗生素，60%的患者使用了质子泵抑制剂（PPIs）。103 例（18%）患者确诊为 CDI。诊断为 CDI 的患者年龄较大，更常为女性，近期住院且卧床不起，且接受了抗生素和 PPI 治疗。通过向后逐步逻辑回归模型，年龄>65 岁、女性、近期住院、近期抗生素治疗、活动性癌症、住院时间延长（>12 天）、低白蛋白血症（白蛋白<3g/dL）和白细胞增多症（白细胞>9×10^9/L）被发现可独立预测 CDI 的发生。这些变量有助于建立一种临床预后评分，对于值>3 的患者具有良好的敏感性和适度的特异性（分别为 79%和 58%；AUC 0.75，95%CI 0.71-0.79，p<0.001），可识别低风险（评分≤3；42.5%）和高风险（评分>3；57.5%）患者。尽管一些经典的危险因素被证实会增加 CDI 的发生，但 CDI 流行病学的变化格局提示需要重新评估常见的危险因素，并根据当地的流行病学情况开发新的风险评分。
