【medical-news】Clin Infect Dis：艰难梭菌感染使住院患者死亡率增加2.5倍

All-cause and disease specific mortality in hospitalized patients with Clostridium difficile infections; a multicenter cohort study

Abstract

Background.



Mortality among patients with Clostridium difficile infections (CDI) is high. Because of high age and multiple underlying diseases, CDI-related mortality is difficult to estimate. We estimated (CDI-related) mortality in an endemic situation, not influenced by outbreaks and consequently certain patients and? C. difficile strains.

Methods.Between 2006 and 2009, 13 Dutch hospitals included all hospitalized CDI patients. Nine hospitals individually matched each CDI patient to two control patients, based on ward and time of CDI hospitalization. Survival status was obtained via the Dutch Civil Registration System. Kaplan Meier and Cox-regression were used for survival analysis.?

Results.We identified 1,366 patients with CDI (1.33 per 1,000 admissions). All cause mortality risk was 13% after 30 days and 37% after 1 year. The highest mortality was seen among elderly patients and patients with PCR ribotype 027. 317 CDI patients were matched to 317 patients without diarrhea and 232 patients with diarrhea, with a 30-day mortality risk of 5.4% and 8.6% respectively. CDI patients had a 2.5 fold increased 30-day mortality rate compared to controls without diarrhea (Hazard ratio 2.5, 95% CI 1.4-4.3) when adjusted for age, sex and underlying diseases. CDI-related death occurred mainly within 30 days after diagnosis.?

Conclusions.Mortality among CDI patients is high, even in an endemic situation. Our study shows that CDI leads to a 2.5 fold increase in 30-day mortality. This highlights the considerable disease burden and clinical impact of CDI, even in absence of an outbreak.?