艰难梭菌无症状携带者危险因素分析

Risk factors of asymptomatic carriers of Clostridium difficile

目的探讨艰难梭菌无症状携带者的危险因素,为制定针对性的预防控制策略提供一定理论依据。方法采用单纯随机抽样,选取2014年9月21-27日于医院住院〉2周的患者128例为研究对象,收集其肛拭子标本,通过厌氧培养,经VIDAS荧光酶联免疫技术进行艰难梭菌毒素A/B检测,利用多重PCR技术进行艰难梭菌毒素基因检测,并利用SPSS 19.0软件进行艰难梭菌无症状携带者危险因素的多因素分析。结果 128例患者肛拭子标本中培养艰难梭菌阳性22株,阳性率为17.19%,均为无症状携带者;单因素分析显示,艰难梭菌无症状携带者在年龄、糖尿病史、使用抗菌药物、抗菌药物使用天数、使用氟喹诺酮类药物等方面差异有统计学意义（P〈0.05）;logistic回归分析显示,近期使用抗菌药物和有糖尿病史可能为患者无症状携带艰难梭菌的独立危险因素,OR值分别为5.70（95%CI：1.69-19.21）和3.86（95%CI：1.21-12.26）。结论医院住院患者艰难梭菌培养阳性率较高,应加强对其监测和筛查,特别是对使用抗菌药物或患有糖尿病的患者更应密切关注。

OBJECTIVE To explore the risk factors of asymptomatic carriers of Clostridium difficile so as to formulate targeted prevention strategies.METHODS By means of single randomized sampling,a total of 128 patients who were hospitalized for more than two weeks from Sep 21,2014 to Sep 27,2014 were recruited as the study objects,then the anal swab specimens were collected for anaerobic culture,the C.difficile toxin A/B was detected by using VIDAS fluorescent enzyme-linked immunoassay,the toxin genes in the C.difficile strains were detected through the multiple PCR technique,and the multivariate analysis was performed for the risk factors of asymptomatic carriers of C.difficile with the use of SPSS 19.0software.RESULTS Of 128 anal swab specimens,22 were cultured positive for the C.difficile,with the positive rate 17.19%;all of the positive cases were asymptomatic carriers.The univariate analysis indicated that there was significant difference in the age,history of diabetic mellitus,use of antibiotics,duration of use of antibiotics,or use of fluoroquinolones（P〈0.05）.The logistic regression analysis showed that the use of antibiotics and history of diabetic mellitus might be the independent risk factors for the asymptomatic carriers of C.difficile,and the OR values were 5.70（95%CI：1.69-19.21）and 3.86（95%CI：1.21-12.26）,respectively.CONCLUSION The positive rate of culture of C.difficile is high in the hospitalized patients.It is necessary to strengthen the surveillance and screening and attach great importance to the patients who use antibiotics or have diabetic mellitus.