肺移植接受者中克洛斯特里迪奥伊德困难感染的初级预防:一项回顾性研究
Mark Irwin1, Nicole Leedy1, Sravanthi Nandavaram2
1Division of Infectious Diseases, Department of Internal Medicine, University of Kentucky, Lexington, Kentucky, USA.
概括
用口服万科米辛或美特罗尼达进行的初级预防并没有防止肺移植接受者 (LTRs) 患有Clostridioides difficile感染 (CDI). 在预防组中观察到较高的死亡率,因此需要在高风险人群中进一步调查.
科学领域:
- 传染性疾病 传染性疾病
- 移植手术 移植手术
- 药理学 药理学是指药理学的学科.
背景情况:
- 艰难菌感染 (CDI) 对固体器官移植受体,特别是肺移植受体 (LTRs) 构成重大风险,通常发生在广泛抗生素使用时.
- 尽管它们在治疗或潜在的预防中发挥着既定的作用,但口服万科米辛或甲尼达对于LTRs的初级CDI预防的疗效仍然不清楚.
研究的目的:
- 在肺移植接受者 (LTRs) 索引入院期间,评估口服万科米辛或美特罗尼达作为针对Clostridioides difficile感染 (CDI) 的初级预防措施的有效性.
主要方法:
- 在2020年1月至2023年5月期间,肯塔基大学对肺移植接受者 (LTR) 进行了回顾性图表审查.
- 患者根据在全身抗生素治疗期间的初级CDI预防药物 (口服万科米辛或美特罗尼达) 的使用而分层.
- 主要终点是指数入院期间的CDI发病率;次要终点包括1年的CDI发病率和所有原因的死亡率.
主要成果:
- 在92名LTR中,51人接受了预防,41人没有. 在索引录取期间,CDI发病率在各组之间是相似的 (2.0%对2.4%).
- 预防组的一年CDI发病率为5.9%,非预防组为2.4% (p=0.626).
- 预防组的全因死亡率明显高 (41.2%对19.5%;p=0.041),可能是由于基线疾病严重程度更高.
结论:
- 用口服万科米辛或美特罗尼达进行的初级预防并没有降低肺移植接受者 (LTRs) 中的CDI发病率.
- 预防在住院时间较长和抗生素疗程较长的患者中更常见.
- 需要对更大的队列进行进一步的研究,以确定在这种脆弱患者群体中初级CDI预防的作用.
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