艰难梭菌感染临床特征与危险因素分析

Clinical characteristics of Clostridium difficile infections and risk factors

目的初步研究广东省人民医院艰难梭菌感染(CDI)的临床特征,并对其相关危险因素进行分析,为提高临床CDI的诊治水平及采取积极有效的预防控制措施奠定基础。方法收集2015年1月-2015年8月间120例住院腹泻患者的粪便标本,进行艰难梭菌毒素A/B检测、厌氧培养,结合临床症状诊断是否为CDI;收集所有患者的临床资料,分析CDI的临床特点和发病相关的危险因素,采用SPSS 17.0对数据进行统计分析。结果 120例腹泻患者中,共检出CDI 24例占20.0%;单次送检、双次送检、三次及以上送检的阳性检出率分别为10.3%、22.2%、73.3%,差异有统计学意义(P<0.05);单因素分析结果显示,年龄≥65岁、男性、糖尿病、帕金森病、广谱青霉素的使用与CDI的发生有关(P<0.05),多因素分析未发现CDI发生的独立危险因素。结论年龄≥65岁、男性、糖尿病、帕金森病、广谱青霉素的使用可能是CDI的危险因素,多次送检粪便标本可以提高CDI的阳性检出率。

OBJECTIVE To preliminarily study the clinical characteristics of Clostridiurn difficile infections in Guangdong General Hospital and analyze the related risk factors so as to improve the level of clinical diagnosis and treatment of the C. difficile infections and take effective prevention measures. METHODS The stool specimens were collected from the 120 diarrhea patients who were hospitalized from Jan 2015 to Aug 2015, then the toxin A/ B of the C. difficile was detected, the anaerobic culture was conducted, the C. difficile infection was deter- mined by combining with the diagnosis of clinical symptoms. The clinical data were collected from all of the pa- tients, the clinical characteristics and the related risk factors for the C. difficile infection were analyzed, and the statistical analysis of data was performed with the use of SPSS 17.0 software. RESULTS Of the 120 diarrhea pa- tients, 24 （20.0%） had the C. difficile infection; the positive rates of detection of single submitted, double sub- mitted, and three-times or more than three-times submitted specimens were 10.3%, 22.2%, and 73.3%, respec- tively, the different was significant （P〈0.05）. The result of the univariate analysis indicated that the incidence of the C. difficile infection was associated with the no less than 65 years of age, male, diabetic mellitus, Parkinsont s disease, and use of broad spectrum of penicillin （P〈0.05） ; the multivariate analysis showed that the independ- ent risk factors for the C. difficile infection were not found. CONCLUSION The risk factors for the C. difficile infection include the no less than 65 years of age, male, diabetic mellitus, Parkinsonts disease, and use of broad spectrum of penicillin. Multiple submission of stool specimens may raise the positive rate of detection of the C. difficile infection.