老年医学科患者艰难梭菌检测结果与定植危险因素分析

Clostridium difficile strains isolated from patients of geriatrics department and risk factors for colonization

目的研究医院老年医学科患者粪便中艰难梭菌的检出率,并分析定植危险因素,为制定有效的预防与控制措施提供理论依据。方法 2014年12月14日开展横断面调查,留取老年医学科78例住院患者的粪便标本,用选择性培养基进行厌氧培养,并利用多重PCR技术进行艰难梭菌毒素基因检测,同时收集所有患者的临床资料,进行艰难梭菌定植高危因素分析;采用SPSS18.0软件进行统计分析。结果 78例患者中艰难梭菌培养阳性36例,阳性率46.15%,均为无症状携带患者;36株艰难梭菌中有tcdA+/tcdB+基因14株占38.89%,tcdA-/tcdB-基因18株占50.00%,tcdA-/tcdB+基因4株占11.11%;患者年龄、住院日、1个月内鼻饲管及抗菌药物的使用为其定植高危因素。结论医院老年医学科住院患者艰难梭菌定植率高,年龄、住院日、1个月内鼻饲管及抗菌药物的使用为其定植高危因素。

OBJECTIVE To investigate the isolation rate of Clostridium difficile strains in stool specimens of geriatrics department patients and analyze the risk factors so as to put forward the effective prevention and control measures.METHODS A cross-sectional survey was conducted on Dec 14,2014,then the stool specimens were collected from 78 patients who were hospitalized the geriatrics department,the anaerobic culture was carried out through selective medium,the genes of the C.difficile strains were detected by using multiple PCR technique,meanwhile,the clinical data of all the patients were obtained,the high risk factors for the C.difficile strains were analyzed,and the statistical analysis was performed with the use of SPSS18.0software.RESULTS Of the 78 patients,36were cultured positive for the C.difficile,with the positive rate 46.15%.Among the 36 C.difficile isolates,14（38.89%）harbored the tcdA＋/tcdB＋ gene,18（50.00%）harbored the tcdA-/tcdB- gene,and4（11.11%）harbored the tcdA-/tcdB＋ gene.The high risk factors included the age,length of hospital stay,and use of nasogastric tube and antibiotics within 1month.CONCLUSIONThe colonization rate of the C.difficile is high in the hospitalized patients of geriatrics department;the high risk factors include the age,length of hospital stay,and use of nasogastric tube and antibiotics within 1month.