目的:本研究的目的是分析和确定儿童癌症患者感染和艰难梭菌感染的可能危险因素。
方法:这是一项回顾性病例对照研究,在一家儿科肿瘤医院进行,涵盖2016-2019年。按年龄和基础疾病进行匹配,对于每种情况,控件的数量从1到3不等。采用Logistic回归模型对危险因素进行评估。
结果:我们分析了63例记录的艰难梭菌感染和125例对照。所有病例都有腹泻,52.4%的患者伴有高于38°C的发热。病例(n=4;6.3%)和对照组(n=6;4.8%;p=0.7)的死亡率相似。总之,病例组中71%的患者和对照组中53%的患者在感染前接受了广谱抗生素。对于以前使用的万古霉素,艰难梭菌感染的几率为5.4(95%置信区间[95CI]2.3-12.5);对于美罗培南,4.41(95CI2.1-9.2);对于头孢吡肟,2.6(95CI1.3-5.1)。对于抗肿瘤剂,卡铂的赔率比为2.7(95CI1.2-6.2),美法兰9.04(95CI1.9-42.3),白消安16.7(95CI2.1-134.9),和天冬酰胺酶8.97(95CI1.9-42.9)。
结论:C.儿童癌症患者的艰难病状感染与既往住院和癌症患者使用常用抗生素有关,比如万古霉素,美罗培南,还有头孢吡肟,在过去的三个月里。化疗药物,如卡铂,melphalan,白消安,和天冬酰胺酶,也是危险因素。
OBJECTIVE: The aim of this study was to analyze and identify documented infections and possible risk factors for Clostridioides difficile infections in children with cancer.
METHODS: This is a retrospective
case-control study, carried out in a pediatric cancer hospital, covering the years 2016-2019. Matching was performed by age and underlying disease, and for each
case, the number of controls varied from 1 to 3. Logistic regression models were used to assess risk factors.
RESULTS: We analyzed 63 cases of documented infection by C. difficile and 125 controls. Diarrhea was present in all cases, accompanied by fever higher than 38°C in 52.4% of the patients. Mortality was similar among cases (n=4; 6.3%) and controls (n=6; 4.8%; p=0.7). In all, 71% of patients in the
case group and 53% in the control group received broad-spectrum antibiotics prior to the infection. For previous use of vancomycin, the Odds Ratio for C. difficile infection was 5.4 (95% confidence interval [95%CI] 2.3-12.5); for meropenem, 4.41 (95%CI 2.1-9.2); and for cefepime, 2.6 (95%CI 1.3-5.1). For the antineoplastic agents, the Odds Ratio for carboplatin was 2.7 (95%CI 1.2-6.2), melphalan 9.04 (95%CI 1.9-42.3),
busulfan 16.7 (95%CI 2.1-134.9), and asparaginase 8.97 (95%CI 1.9-42.9).
CONCLUSIONS: C. difficile symptomatic infection in children with cancer was associated with previous hospitalization and the use of common antibiotics in cancer patients, such as vancomycin, meropenem, and cefepime, in the last 3 months. Chemotherapy drugs, such as carboplatin, melphalan,
busulfan, and asparaginase, were also risk factors.