Dokument: Risikofaktoren und Krankheitsverlauf einer Clostridioides difficile-Infektion in einer Kohorte dialysepflichtiger Patienten mit Diarrhoen
| Titel: | Risikofaktoren und Krankheitsverlauf einer Clostridioides difficile-Infektion in einer Kohorte dialysepflichtiger Patienten mit Diarrhoen | |||||||
| Weiterer Titel: | Risk factors and disease course of Clostridioides difficile infection in a cohort of dialysis patients with diarrhoea | |||||||
| URL für Lesezeichen: | https://docserv.uni-duesseldorf.de/servlets/DocumentServlet?id=66422 | |||||||
| URN (NBN): | urn:nbn:de:hbz:061-20240729-110908-5 | |||||||
| Kollektion: | Dissertationen | |||||||
| Sprache: | Deutsch | |||||||
| Dokumententyp: | Wissenschaftliche Abschlussarbeiten » Dissertation | |||||||
| Medientyp: | Text | |||||||
| Autor: | Chakupurakal, Roy [Autor] | |||||||
| Dateien: |
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| Beitragende: | Prof. Dr. Koch, Michael [Gutachter] Prof. Dr. Germing, Ulrich [Gutachter] | |||||||
| Dewey Dezimal-Klassifikation: | 600 Technik, Medizin, angewandte Wissenschaften » 610 Medizin und Gesundheit | |||||||
| Beschreibungen: | Eine Clostridioides difficile-Infektion (CDI, vormals Clostridium difficile-Infektion) ist eine infektiöse Colitis, die durch das gleichnamige sporenbildende Bakterium ausgelöst wird. Die Infektion tritt häufig als Komplikation von Antibiotikabehandlungen, Krankenhausaufenthalten sowie einiger anderer Risikofaktoren auf. Die Infektion stellt ein zunehmendes Problem im Gesundheitssystem dar. Sie geht mit einer erhöhten Morbidität, einer verlängerten Krankenhausaufenthaltsdauer, einer gesteigerten Mortalität und damit verbundenen vermehrten Kosten im Gesundheitssystem einher. Besonders Dialysepatienten neigen aufgrund mehrerer Faktoren häufiger zu einer CDI. Diese zeigt sich dann häufiger mit langen, teilweise therapierefraktären und schweren Krankheitsverläufen. Die Therapie ist dementsprechend häufig länger und intensiver in diesem Patientenkollektiv.
Ziel dieser Studie war es, eine Kohorte von chronischen Dialysepatienten in Deutschland, die Diarrhoen entwickelt haben, zu untersuchen. In dieser Kohorte sollten Risikofaktoren identifizieren werden, die schon beim Auftreten von Diarrhoen eine Unterscheidung ermöglichen, ob es sich um eine CDI oder andersartige Durchfällerkrankung handelt. 339 chronische Dialysepatienten einer großen Dialysepraxis in Deutschland, die Diarrhoen im Indexzeitraum von 2014 – 2018 entwickelt hatten, wurden erfasst und in zwei Gruppen eingeteilt (CDI-positive Fall- und CDI-negative Kontrollgruppe). Die Gruppen wurden gegeneinander bezüglich möglicher Risikofaktoren, die eine CDI begünstigen, verglichen. Bekannte Risikofaktoren und weitere Faktoren wurden weiter analysiert. In univariaten Untersuchungen sowie multivariaten logistischen Regressionsmodellen ließ sich feststellen, dass eine Hypalbuminämie und eine Antibiotikatherapie im Zeitraum von drei Monaten vor Indexzeitpunkt (Zeitpunkt der Stuhluntersuchung) mit einer CDI assoziiert waren. Faktoren wie Krankenhausaufenthalte, Peritonitis als Vorerkrankung, spezifische Antibiotika wie Penicillinderivate, Cephalosporine, Carbapeneme und Chinolone sowie Anämie waren zwar in univariaten Analysen mit einer CDI assoziiert, jedoch nicht mehr in den multivariaten logistischen Regressionsmodellen. So konnte zum Beispiel in den univariaten Analysen eine signifikante Assoziation zwischen Krankenhausaufenthalten und einer CDI festgestellt werden. Dieses war nicht mehr in den multivariaten Berechnungen zu erkennen. Es zeigte sich zum Beispiel, dass die in diesem Zeitraum verabreichte Antibiotikagabe, der eigentliche Risikofaktor waren. Auffallend war, dass ein Diabetes mellitus (sowie ein entsprechend erhöhter HbA1c-Wert) in einer Population von Dialysepatienten mit Diarrhoen, die wegen Diarrhoe selektiert wurde, mit einer geringeren Häufigkeit von CDI assoziiert war. Der Diabetes mellitus verursacht über eine Reihe von Mechanismen, wie zum Beispiel einer autonomen Neuropathie, Diarrhoen. Diabetes mellitus ergab sich deshalb als risikoreduzierender Konfounder. Die Ergebnisse zeigen, dass chronische Dialysepatienten mit neu aufgetretenen Diarrhoen, die eine Hypalbuminämie und zuvor stattgehabte Antibiotikatherapie aufweisen, eher an einer CDI leiden und dann frühzeitig eine entsprechende Diagnostik und Therapie erhalten sollten.Clostridioides difficile infection (CDI, formerly Clostridium difficile infection) is an infectious colitis caused by the spore-forming bacterium of the same name. The infection often occurs as a complication of antibiotic treatments, hospitalization, and other risk factors. The infection represents an increasing problem to the healthcare system. It is associated with increased morbidity, prolonged hospitalization, increased mortality, and associated increased costs in the healthcare system. Dialysis patients in particular are more likely to develop CDI due to several factors. This then manifests itself more frequently with long, sometimes treatment-refractory and severe disease presentation. The therapy is therefore often longer and more intensive in this particular patient population. The aim of this study was to examine a cohort of chronic dialysis patients in Germany who developed diarrhea. In this cohort, risk factors should be identified that make it possible to distinguish whether it is CDI or another type of diarrhea when the symptom occurs. This knowledge could potentially be used for early treatment of CDI with the aim of a better outcome for the disease. 339 chronic dialysis patients from a large dialysis practice in Germany who had developed diarrhea in the index period from 2014 to 2018 were recorded and divided into two groups (CDI-positive case group and CDI-negative control group). The groups were compared to each other regarding potential risk factors that promote CDI. Known risk factors and other factors were further analyzed. In univariate studies and multivariate logistic regression models, it was found that hypoalbuminemia and antibiotic therapy in the period of three months before the index time (time of stool examination) were associated with CDI. Factors such as hospital stays, peritonitis as a previous illness, specific antibiotics such as penicillin derivatives, cephalosporins, carbapenems and quinolones as well as anemia were associated with CDI in univariate analyzes but no longer in the multivariate logistic regression models. For example, the hospital stays seen as a risk factor for CDI in univariate analyzes are primarily explained in the multivariate calculations by, among other things, the administered antibiotics during this period. Strikingly, diabetes mellitus (and a correspondingly elevated HbA1c value) was associated with a lower frequency of CDI in a population of dialysis patients with diarrhea selected for diarrhea. Diabetes mellitus causes diarrhea through a number of mechanisms such as autonomic neuropathy. Diabetes mellitus was there a risk-reducing confounder in this study. The results show that chronic dialysis patients with new diarrhea who have hypoalbuminemia and previous antibiotic therapy are more likely to suffer from CDI and should then receive appropriate diagnostics and therapy at an early stage. | |||||||
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| Lizenz: |  Dieses Werk ist lizenziert unter einer Creative Commons Namensnennung 4.0 International Lizenz | |||||||
| Fachbereich / Einrichtung: | Medizinische Fakultät | |||||||
| Dokument erstellt am: | 29.07.2024 | |||||||
| Dateien geändert am: | 29.07.2024 | |||||||
| Promotionsantrag am: | 24.03.2024 | |||||||
| Datum der Promotion: | 23.07.2024 |
