{"title":"重症监护室患者艰难梭菌感染的危险因素和结局。","authors":"Tingting Hou, Yifang Huang, Jinjun Jiang, Yuanlin Song, Shujing Chen","doi":"10.1111/crj.70130","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>This retrospective study aimed to investigate the risk factors and clinical outcomes of Clostridioides difficile infection (CDI) in critically ill patients admitted to the respiratory intensive care unit (RICU).</p><p><strong>Methods: </strong>We enrolled adult patients who developed diarrhea during their stay in the RICU and underwent C. difficile toxin testing. Patients were stratified into two groups based on test results: CDI group and Clostridioides difficile-negative diarrhea (CDN) group. Risk factors for CDI and clinical outcomes were compared between the two groups.</p><p><strong>Results: </strong>The incidence of CDI in RICU patients was 8.3%. Compared with the CDN group, the CDI group had significantly lower PaO<sub>2</sub>/FiO<sub>2</sub> (P/F) ratios (median 135 vs. 189 mmHg, p = 0.012) and higher rates of parenteral nutrition (83.78% vs. 60.0%, p = 0.012), vasopressor use (62.16% vs. 40.0%, p = 0.029), and analgesic administration (72.97% vs. 47.14%, p = 0.01). Multivariate analysis indicated that male sex was a risk factor for CDI (OR, 4.07; 95% CI, 1.25-13.26; p = 0.02). The CDI group had a nonsignificantly higher 60-day mortality rate (35.14% vs. 34.29%; p = 0.976). Survivors of CDI patients exhibited better oxygenation (175.43 vs. 102.88 mmHg; p = 0.004) and lower SOFA scores (6.38 vs. 9.0; p = 0.017). No independent risk factors for mortality were identified. CDI patients had significantly longer RICU stays (median: 32 vs. 21.5 days, p = 0.02).</p><p><strong>Conclusion: </strong>In this study, male sex was independently associated with an increased risk of CDI. Although CDI did not significantly affect 60-day mortality, it was linked to prolonged RICU hospitalization.</p>","PeriodicalId":55247,"journal":{"name":"Clinical Respiratory Journal","volume":"19 10","pages":"e70130"},"PeriodicalIF":2.3000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Risk Factors and Outcomes of Clostridioides difficile Infection in Respiratory Intensive Care Unit Patients.\",\"authors\":\"Tingting Hou, Yifang Huang, Jinjun Jiang, Yuanlin Song, Shujing Chen\",\"doi\":\"10.1111/crj.70130\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>This retrospective study aimed to investigate the risk factors and clinical outcomes of Clostridioides difficile infection (CDI) in critically ill patients admitted to the respiratory intensive care unit (RICU).</p><p><strong>Methods: </strong>We enrolled adult patients who developed diarrhea during their stay in the RICU and underwent C. difficile toxin testing. Patients were stratified into two groups based on test results: CDI group and Clostridioides difficile-negative diarrhea (CDN) group. Risk factors for CDI and clinical outcomes were compared between the two groups.</p><p><strong>Results: </strong>The incidence of CDI in RICU patients was 8.3%. Compared with the CDN group, the CDI group had significantly lower PaO<sub>2</sub>/FiO<sub>2</sub> (P/F) ratios (median 135 vs. 189 mmHg, p = 0.012) and higher rates of parenteral nutrition (83.78% vs. 60.0%, p = 0.012), vasopressor use (62.16% vs. 40.0%, p = 0.029), and analgesic administration (72.97% vs. 47.14%, p = 0.01). Multivariate analysis indicated that male sex was a risk factor for CDI (OR, 4.07; 95% CI, 1.25-13.26; p = 0.02). The CDI group had a nonsignificantly higher 60-day mortality rate (35.14% vs. 34.29%; p = 0.976). Survivors of CDI patients exhibited better oxygenation (175.43 vs. 102.88 mmHg; p = 0.004) and lower SOFA scores (6.38 vs. 9.0; p = 0.017). No independent risk factors for mortality were identified. CDI patients had significantly longer RICU stays (median: 32 vs. 21.5 days, p = 0.02).</p><p><strong>Conclusion: </strong>In this study, male sex was independently associated with an increased risk of CDI. 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引用次数: 0
摘要
目的：本回顾性研究旨在探讨呼吸道重症监护病房（RICU）危重患者艰难梭菌感染（CDI）的危险因素及临床结局。方法：我们招募了在RICU住院期间出现腹泻并进行艰难梭菌毒素检测的成年患者。根据检测结果将患者分为CDI组和艰难梭菌阴性腹泻（CDN）组。比较两组CDI的危险因素和临床结果。结果：RICU患者CDI发生率为8.3%。与CDN组相比，CDI组PaO2/FiO2 （P/F）比值显著降低（中位数135比189 mmHg， P = 0.012），肠外营养（83.78%比60.0%,P = 0.012）、血管加压药（62.16%比40.0%,P = 0.029）和镇痛药（72.97%比47.14%,P = 0.01）的使用比例较高。多因素分析显示，男性是CDI的危险因素（OR, 4.07; 95% CI, 1.25-13.26; p = 0.02）。CDI组60天死亡率无显著性增高（35.14% vs. 34.29%; p = 0.976）。CDI患者的幸存者表现出更好的氧合（175.43比102.88 mmHg, p = 0.004）和更低的SOFA评分（6.38比9.0,p = 0.017）。未发现死亡的独立危险因素。CDI患者的RICU停留时间显著延长（中位数：32天vs. 21.5天，p = 0.02）。结论：在本研究中，男性与CDI风险增加独立相关。虽然CDI对60天死亡率没有显著影响，但它与RICU住院时间延长有关。
Risk Factors and Outcomes of Clostridioides difficile Infection in Respiratory Intensive Care Unit Patients.
Objective: This retrospective study aimed to investigate the risk factors and clinical outcomes of Clostridioides difficile infection (CDI) in critically ill patients admitted to the respiratory intensive care unit (RICU).
Methods: We enrolled adult patients who developed diarrhea during their stay in the RICU and underwent C. difficile toxin testing. Patients were stratified into two groups based on test results: CDI group and Clostridioides difficile-negative diarrhea (CDN) group. Risk factors for CDI and clinical outcomes were compared between the two groups.
Results: The incidence of CDI in RICU patients was 8.3%. Compared with the CDN group, the CDI group had significantly lower PaO2/FiO2 (P/F) ratios (median 135 vs. 189 mmHg, p = 0.012) and higher rates of parenteral nutrition (83.78% vs. 60.0%, p = 0.012), vasopressor use (62.16% vs. 40.0%, p = 0.029), and analgesic administration (72.97% vs. 47.14%, p = 0.01). Multivariate analysis indicated that male sex was a risk factor for CDI (OR, 4.07; 95% CI, 1.25-13.26; p = 0.02). The CDI group had a nonsignificantly higher 60-day mortality rate (35.14% vs. 34.29%; p = 0.976). Survivors of CDI patients exhibited better oxygenation (175.43 vs. 102.88 mmHg; p = 0.004) and lower SOFA scores (6.38 vs. 9.0; p = 0.017). No independent risk factors for mortality were identified. CDI patients had significantly longer RICU stays (median: 32 vs. 21.5 days, p = 0.02).
Conclusion: In this study, male sex was independently associated with an increased risk of CDI. Although CDI did not significantly affect 60-day mortality, it was linked to prolonged RICU hospitalization.
期刊介绍：
Overview
Effective with the 2016 volume, this journal will be published in an online-only format.
Aims and Scope
The Clinical Respiratory Journal (CRJ) provides a forum for clinical research in all areas of respiratory medicine from clinical lung disease to basic research relevant to the clinic.
We publish original research, review articles, case studies, editorials and book reviews in all areas of clinical lung disease including:
Asthma
Allergy
COPD
Non-invasive ventilation
Sleep related breathing disorders
Interstitial lung diseases
Lung cancer
Clinical genetics
Rhinitis
Airway and lung infection
Epidemiology
Pediatrics
CRJ provides a fast-track service for selected Phase II and Phase III trial studies.
Keywords
Clinical Respiratory Journal, respiratory, pulmonary, medicine, clinical, lung disease,
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