血液病患者产毒素艰难梭菌定植与感染的危险因素研究

Risk factors for toxigenic Clostridium difficile colonization and infection among inpatients with hematologic disease

目的了解血液病患者产毒素艰难梭菌定植(tCDC)与艰难梭菌感染(CDI)的危险因素,为实施有效的防控方案提供依据。方法 2014年4月1日和9月2日,通过两次横断面调查采集183例血液病患者粪便标本进行艰难梭菌培养与A/B毒素检测,结合临床症状及病历资料,分析tCDC和CDI的影响因素。结果单因素研究发现tCDC和CDI的共同危险因素是2个月内有住院史、接受化疗,2个月内接触≥3种的抗菌药物;logistic回归多因素分析发现2个月内有住院史、累计使用抗菌药物>30d、使用第二代头孢菌素是tCDC的独立危险因素,而2个月内接触≥3种抗菌药物、累计使用抗菌药物>15d是发生CDI的独立危险因素。结论血液病患者存在tCDC和CDI的多种危险因素,两者有一定联系又有差异,对制定科学的艰难梭菌防控策略具有一定参考意义。

OBJECTIVE To identify risk factors associated toxigenic Clostridium difficile colonization（tCDC）and C.difficileinfection（CDI）in hematologic disease patients,so as to provide evidence for implementation effective prevention and control measures.METHODS A total of 183 cases of patients with hematologic disease received twice cross-sectional study from 1st of Apr.to 2nd of Sep.2014,and their stool specimens were collected to C.difficile culture and tcdA/tcdBtoxin detection.Clinical symptoms and medical information were collected to determine the risk factors of tCDC and CDI.RESULTS According to univariate analysis,we found that hospitalization in the previous 2months,chemotherapy,use of more than 3type of antibiotics within 2months were associated with both tCDC and CDI.While through the multivariate analysis,admission to hospital within two months,the cumulative using of antibiotics for more than 30 days and using of the second generation of cephalosporin were the independent risk factors for tCDC.Exposure to more than 3type of antibiotics and cumulative use of antibiotics for more than 15 days were the independent risk factors for CDI.CONCLUSIONThere were many risk factors associated with tCDC and CDI within hematologic disease patients,which were associated but differential.It would provide us with significant references to develop scientific strategies for prevention and control of C.difficile.