研究动态
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墨西哥艰难梭菌感染的多中心研究:探索景观。

Multicenter study on Clostridioides difficile infections in Mexico: exploring the landscape.

发表日期:2024 Oct 21
作者: Daniel De-la-Rosa-Martinez, Diana Vilar-Compte, Nancy Martínez-Rivera, Eric Ochoa-Hein, Rayo Morfin-Otero, María Esther Rangel-Ramírez, Pamela Garciadiego-Fossas, Juan Luis Mosqueda-Gómez, Ana Patricia Rodríguez Zulueta, Isaí Medina-Piñón, Rafael Franco-Cendejas, Christian Gerardo Alfaro-Rivera, Norma Eréndira Rivera-Martínez, Jonathan Mendoza-Barragán, Alicia Estela López-Romo, Marisol Manríquez-Reyes, David Humberto Martínez-Oliva, Samantha Flores-Treviño, Jhoan M Azamar-Marquez, Lirio Nathali Valverde-Ramos, José Raúl Nieto-Saucedo, Sara Alejandra Aguirre-Díaz, Adrián Camacho-Ortiz,
来源: INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY

摘要:

本研究旨在概述 COVID-19 大流行期间墨西哥医疗机构中艰难梭菌感染 (CDI) 的趋势和结果。病例系列的观察性研究。2016 年 1 月至 2022 年 12 月墨西哥八个州的 16 家公立医院和私立学术医疗机构.CDI 患者。CDI 患者的人口统计学、临床和实验室数据来自临床记录。病例被归类为社区或医疗保健相关感染,发病率按每 10,000 个患者日的病例数计算。通过多变量逻辑回归分析 30 天全因死亡率的危险因素。我们确定了 2,356 例 CDI 病例:2,118 例 (90%) 与医疗保健相关,232 例 (10%) 与社区相关。常见的合并症包括高血压、糖尿病和癌症。此前观察到质子泵抑制剂、类固醇和抗生素的大量使用。 112 名患者(5%)出现复发感染,371 名患者(16%)30 天死亡。与死亡相关的危险因素包括高查尔森评分、既往使用类固醇、同时使用抗生素、白细胞减少、白细胞增多、血清肌酸升高、低蛋白血症、脓毒性休克或腹部败血症以及 SARS-CoV-2 合并感染。在大流行前和大流行期间,与医疗保健相关的 CDI 发病率稳定在每 10,000 名患者日 4.78 例。然而,公立医院的发病率较高。我们的研究强调了墨西哥机构进行常规流行病学监测和标准化 CDI 分类方案的必要性。尽管我国的 CDI 率与一些欧洲国家的水平一致,但公共和私营医疗保健部门之间的差异强调了有针对性的干预措施的重要性。
This study aims to outline Clostridioides difficile infection (CDI) trends and outcomes in Mexican healthcare facilities during the COVID-19 pandemic.Observational study of case series.Sixteen public hospitals and private academic healthcare institutions across eight states in Mexico from January 2016 to December 2022.CDI patients.Demographic, clinical, and laboratory data of CDI patients were obtained from clinical records. Cases were classified as community or healthcare-associated infections, with incidence rates calculated as cases per 10,000 patient days. Risk factors for 30-day all-cause mortality were analyzed by multivariate logistic regression.We identified 2,356 CDI cases: 2,118 (90%) were healthcare-associated, and 232 (10%) were community-associated. Common comorbidities included hypertension, diabetes, and cancer. Previous high use of proton-pump inhibitors, steroids, and antibiotics was observed. Recurrent infection occurred in 112 (5%) patients, and 30-day mortality in 371 (16%). Risk factors associated with death were a high Charlson score, prior use of steroids, concomitant use of antibiotics, leukopenia, leukocytosis, elevated serum creatine, hypoalbuminemia, septic shock or abdominal sepsis, and SARS-CoV-2 coinfection. The healthcare-associated CDI incidence remained stable at 4.78 cases per 10,000 patient days during the pre-and pandemic periods. However, the incidence was higher in public hospitals.Our study underscores the need for routine epidemiology surveillance and standardized CDI classification protocols in Mexican institutions. Though CDI rates in our country align with those in some European countries, disparities between public and private healthcare sectors emphasize the importance of targeted interventions.