Bignardi G E
Microbiology Department, Sunderland Royal Hospital, UK.
J Hosp Infect. 1998 Sep;40(1):1-15. doi: 10.1016/s0195-6701(98)90019-6.
A systematic review of the literature to identify risk factors associated with Clostridium difficile infection was conducted. Two main outcomes were considered: C. difficile diarrhoea and C. difficile carriage. A qualitative assessment, based on a set of defined and consistently applied criteria, appeared to be the best approach for risk factors other than antibiotic use, as an approach based on meta-analysis would have utilized only the information provided by a minority of the studies. Risk factors for which there was evidence suggestive or consistent with an association with C. difficile diarrhoea were: increasing age (excluding infancy), severity of underlying diseases, non-surgical gastrointestinal procedures, presence of a nasogastric tube, anti-ulcer medications, stay on ITU, duration of hospital stay, duration of antibiotic course, administration of multiple antibiotics. For malignant haematological disorders there was evidence of an association only with C. difficile carriage, but there were no suitable studies to explore a possible association of this risk factor with symptomatic infection. Antibiotic use lent itself to quantitative assessment with meta-analysis using logistic regression. Exposure to an antibiotic was shown to be statistically significantly associated with both C. difficile diarrhoea and C. difficile carriage. The meta-analysis approach enabled the ranking of individual antibiotics in relation to the risk of C. difficile infection, though the 95% confidence intervals were often wide and overlapping. Antibiotics associated with a lower risk of C. difficile diarrhoea should be considered, especially when attempting to control a C. difficile outbreak or when prescribing for a patient with other C. difficile risk factors. This systematic review of the literature enabled the identification of features it would be desirable to consider in future epidemiological studies.
我们进行了一项文献系统综述，以确定与艰难梭菌感染相关的风险因素。主要考虑了两个结果：艰难梭菌腹泻和艰难梭菌携带。对于除抗生素使用以外的风险因素，基于一组明确且始终适用的标准进行定性评估似乎是最佳方法，因为基于荟萃分析的方法仅会利用少数研究所提供的信息。有证据表明与艰难梭菌腹泻存在关联或与之相符的风险因素包括：年龄增长（不包括婴儿期）、基础疾病的严重程度、非手术性胃肠道操作、鼻胃管的存在、抗溃疡药物、在重症监护病房的停留时间、住院时间、抗生素疗程时长、多种抗生素的使用。对于恶性血液系统疾病，仅有证据表明与艰难梭菌携带存在关联，但没有合适的研究来探讨该风险因素与症状性感染之间可能存在的关联。抗生素使用适合通过逻辑回归进行荟萃分析的定量评估。已表明接触抗生素在统计学上与艰难梭菌腹泻和艰难梭菌携带均显著相关。荟萃分析方法能够对个别抗生素与艰难梭菌感染风险的关系进行排序，尽管95%置信区间往往较宽且相互重叠。应考虑使用与较低艰难梭菌腹泻风险相关的抗生素，尤其是在试图控制艰难梭菌暴发时或为具有其他艰难梭菌风险因素的患者开处方时。这项文献系统综述有助于确定未来流行病学研究中值得考虑的特征。
