Evaluating Risk Factors for Clostridium difficile Infection (CDI) In Stem Cell Transplant (SCT) Recipients: A National Study 公开
Shah, Nishi Nilesh (2014)
Abstract
Introduction: Clostridium difficile infections (CDI) are the leading cause of infectious diarrhea among patients undergoing stem cell transplantation (SCT). Autologous and allogeneic SCTs differ in terms of indications, preparatory regimen, length of stay and their rationale for efficacy. We have therefore analyzed National Inpatient Sample (NIS) database provided by Healthcare Cost and Utilization Project (HCUP) separately for autologous and allogeneic SCT recipients to evaluate risk factors for CDI.
Methods: We used the NIS database to study adult patients admitted for primary procedures of autologous and allogeneic SCT between 01/2001 until 12/2010. We performed separate multivariate logistic regression analyses to evaluate risk factors of CDI in auto and allo-SCT pts. Comorbidities and clinical variables were identified using comorbidity and clinical classification software (CCS) by HCUP. SAS 9.3 was used for analyses.
Results: Autologous SCTs constituted 61.5% of SCTs performed. Out of the 53072 auto-SCTs performed, 6% reported CDI while 8.5% of allo-SCTs reported CDI. Univariate analyses identified age, gender, indication for transplant, radiation, respiratory failure, septicemia, lengthy hospital stay and multiple comorbidities as risk factors for CDI in both subsets. On multivariate analyses, there was significant interaction between age and the indication for transplant (p=0.003) No particular indication for auto and allo-SCT was associated with CDI on multivariate analyses. Septicemia was associated with higher CDI in both auto (OR=1.64 [1.35-2]) and allo-SCTs (OR=1.69 [1.36-2.1]). Males were at a higher risk for CDI (auto-SCT OR=1.29 [1.09-1.53] and allo-SCT OR=1.36 [1.18-1.57]). Patients who stayed longer had a higher risk of developing CDI (auto-SCT OR= 2.81 [2.29-3.45] and allo-SCT OR=2.63 [2.15-3.22]). There was an association between CDI and the presence of multiple co-morbidities among autologous SCTs (OR=1.32 [1.11-1.57]), and allogeneic SCTs (OR=1.18 [1.0-1.4]).
Conclusions: The incidence of CDI is higher among allogeneic SCTs. CDI was associated with longer hospital stay, septicemia and male gender for auto and allo-SCTs. While this analysis does not permit us to directly ascribe the associations to be causative for CDI, it helps us identify the more vulnerable population for CDI, and provides a rationale for development of effective approaches for preventing CDI in this population.
Table of Contents
Abstract............................................................................................................... 2
Introduction.................................................................................. ....................... 9
Methods.............................................................................................................. 11
Results..................................................................................................... .......... 15
Discussion .......................................................................................................... 20
Tables………………………………………………………………………………………………………………………........…. 27
Figures………………………………………………………………………………………………………………………….........33
References…................................................................................................. .......36
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Evaluating Risk Factors for Clostridium difficile Infection (CDI) In Stem Cell Transplant (SCT) Recipients: A National Study () | 2018-08-28 12:42:04 -0400 |
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