临床时讯 ＞ 临床研究
美国一项研究提示，医院获得性难辨梭状芽孢杆菌（艰难梭菌）感染延长患者住院时间且与基线死亡风险无关。论文12月5日在线发表于《加拿大医学会杂志》（Canadian Medical Association Journal）。
CMAJ. 2011 Dec 5. [Epub ahead of print]
The effect of hospital-acquired infection with Clostridium difficile on length of stay in hospital.
Forster AJ, Taljaard M, Oake N, Wilson K, Roth V, van Walraven C.
BACKGROUND: The effect of hospital-acquired infection with Clostridium difficile on length of stay in hospital is not yet fully understood. We determined the independent impact of hospital-acquired infection withC. difficile on length of stay in hospital.
METHODS: We conducted a retrospective observational cohort study of admissions to hospital between July 1, 2002, and Mar. 31, 2009, at a single academic hospital. We measured the association between infection with hospital-acquired C. difficile and time to discharge from hospital using Kaplan-Meier methods and a Cox multivariable proportional hazards regression model. We controlled for baseline risk of death and accounted for C. difficile as a time-varying effect.
RESULTS: Hospital-acquired infection with C. difficile was identified in 1393 of 136 877 admissions to hospital (overall risk 1.02%, 95% confidence interval [CI] 0.97%-1.06%). The crude median length of stay in hospital was greater for patients with hospital-acquired C. difficile (34 d) than for those without C. difficile (8 d). Survival analysis showed that hospital-acquired infection with C. difficile increased the median length of stay in hospital by six days. In adjusted analyses, hospital-acquired C. difficile was significantly associated with time to discharge, modified by baseline risk of death and time to acquisition of C. difficile. The hazard ratio for discharge by day 7 among patients with hospital-acquired C. difficile was 0.55 (95% CI 0.39-0.70) for patients in the lowest decile of baseline risk of death and 0.45 (95% CI 0.32-0.58) for those in the highest decile; for discharge by day 28, the corresponding hazard ratios were 0.74 (95% CI 0.60-0.87) and 0.61 (95% CI 0.53-0.68).
INTERPRETATION: Hospital-acquired infection with C. difficile significantly prolonged length of stay in hospital independent of baseline risk of death.