PDF(Pubmed)
Abstract：
BACKGROUND: Clostridioides difficile infection (CDI) is a major public health threat. Up to 40% of patients with CDI experience recurrent CDI (rCDI), which is associated with increased morbidity. This study aimed to define an at-risk population by obtaining a detailed understanding of the different factors leading to CDI, rCDI, and CDI-related morbidity and of time to CDI.
METHODS: We conducted a systematic literature review (SLR) of MEDLINE (using PubMed) and EMBASE for relevant articles published between January 1, 2016, and November 11, 2022, covering the US population.
RESULTS: Of the 1324 articles identified, 151 met prespecified inclusion criteria. Advanced patient age was a likely risk factor for primary CDI within a general population, with significant risk estimates identified in nine of 10 studies. Older age was less important in specific populations with comorbidities usually diagnosed at earlier age, such as bowel disease and cancer. In terms of comorbidities, the established factors of infection, kidney disease, liver disease, cardiovascular disease, and bowel disease along with several new factors (including anemia, fluid and electrolyte disorders, and coagulation disorders) were likely risk factors for primary CDI. Data on diabetes, cancer, and obesity were mixed. Other primary CDI risk factors were antibiotics, proton pump inhibitors, female sex, prior hospitalization, and the length of stay in hospital. Similar factors were identified for rCDI, but evidence was limited. Older age was a likely risk factor for mortality. Timing of primary CDI varied depending on the population: 2-3 weeks in patients receiving stem cell transplants, within 3 weeks for patients undergoing surgery, and generally more than 3 weeks following solid organ transplant.
CONCLUSIONS: This SLR uses recent evidence to define the most important factors associated with CDI, confirming those that are well established and highlighting new ones that could help to identify patient populations at high risk.
METHODS: We conducted a systematic literature review (SLR) of MEDLINE (using PubMed) and EMBASE for relevant articles published between January 1, 2016, and November 11, 2022, covering the US population.
RESULTS: Of the 1324 articles identified, 151 met prespecified inclusion criteria. Advanced patient age was a likely risk factor for primary CDI within a general population, with significant risk estimates identified in nine of 10 studies. Older age was less important in specific populations with comorbidities usually diagnosed at earlier age, such as bowel disease and cancer. In terms of comorbidities, the established factors of infection, kidney disease, liver disease, cardiovascular disease, and bowel disease along with several new factors (including anemia, fluid and electrolyte disorders, and coagulation disorders) were likely risk factors for primary CDI. Data on diabetes, cancer, and obesity were mixed. Other primary CDI risk factors were antibiotics, proton pump inhibitors, female sex, prior hospitalization, and the length of stay in hospital. Similar factors were identified for rCDI, but evidence was limited. Older age was a likely risk factor for mortality. Timing of primary CDI varied depending on the population: 2-3 weeks in patients receiving stem cell transplants, within 3 weeks for patients undergoing surgery, and generally more than 3 weeks following solid organ transplant.
CONCLUSIONS: This SLR uses recent evidence to define the most important factors associated with CDI, confirming those that are well established and highlighting new ones that could help to identify patient populations at high risk.
摘要：
背景：艰难梭菌感染（CDI）是主要的公共卫生威胁。高达40％的CDI患者经历复发性CDI（rCDI），这与发病率增加有关。本研究旨在通过详细了解导致CDI的不同因素来定义高危人群。rCDI,和CDI相关的发病率和CDI的时间。
方法：我们对MEDLINE（使用PubMed）和EMBASE在2016年1月1日至2022年11月11日之间发表的相关文章进行了系统文献综述（SLR），涵盖了美国人群。
结果：在确定的1324篇文章中，151符合预定的纳入标准。在普通人群中，高龄患者可能是原发性CDI的危险因素。在10项研究中的9项研究中确定了显著的风险估计。在通常在较早年龄诊断为合并症的特定人群中，年龄较小，如肠道疾病和癌症。在合并症方面，既定的感染因素，肾病,肝病,心血管疾病,和肠道疾病以及几个新的因素(包括贫血，液体和电解质紊乱，和凝血障碍）可能是原发性CDI的危险因素。关于糖尿病的数据，癌症,和肥胖混合在一起。其他主要的CDI危险因素是抗生素，质子泵抑制剂,女性性别,之前住院，以及住院时间。rCDI也确定了类似的因素，但证据有限.高龄可能是死亡的危险因素。原发性CDI的时间因人群而异：接受干细胞移植的患者为2-3周，接受手术的患者在3周内，通常在实体器官移植后超过3周。
结论：本SLR使用最新证据来定义与CDI相关的最重要因素，确认那些已经建立的，并突出显示新的，可以帮助识别高危患者人群。
方法：我们对MEDLINE（使用PubMed）和EMBASE在2016年1月1日至2022年11月11日之间发表的相关文章进行了系统文献综述（SLR），涵盖了美国人群。
结果：在确定的1324篇文章中，151符合预定的纳入标准。在普通人群中，高龄患者可能是原发性CDI的危险因素。在10项研究中的9项研究中确定了显著的风险估计。在通常在较早年龄诊断为合并症的特定人群中，年龄较小，如肠道疾病和癌症。在合并症方面，既定的感染因素，肾病,肝病,心血管疾病,和肠道疾病以及几个新的因素(包括贫血，液体和电解质紊乱，和凝血障碍）可能是原发性CDI的危险因素。关于糖尿病的数据，癌症,和肥胖混合在一起。其他主要的CDI危险因素是抗生素，质子泵抑制剂,女性性别,之前住院，以及住院时间。rCDI也确定了类似的因素，但证据有限.高龄可能是死亡的危险因素。原发性CDI的时间因人群而异：接受干细胞移植的患者为2-3周，接受手术的患者在3周内，通常在实体器官移植后超过3周。
结论：本SLR使用最新证据来定义与CDI相关的最重要因素，确认那些已经建立的，并突出显示新的，可以帮助识别高危患者人群。
