脓毒性休克合并艰难梭状芽孢杆菌感染的危险因素分析

The clinical features of Clostridium difficile infection in patients with septic shock

目的艰难梭状芽孢杆菌是导致重症患者预后不良、住院时间延长的主要因素,本研究旨在分析脓毒性休克患者并发艰难梭状芽孢杆菌感染的危险因素。方法回顾性分析2015年1月—2016年12月宁波市第二医院收治的218例脓毒性休克患者的临床资料,根据是否并发艰难梭状芽孢杆菌感染,将患者分为感染组(n=56)和未感染组(n=162)。比较2组临床特征及干预情况,并采用多因素Logistic回归分析方法分析艰难梭状芽孢杆菌感染的危险因素。结果感染组患者入院时APPACHEⅡ评分≥20分(57.14%vs.31.48%,P=0.001)、血乳酸水平≥4 mmol/L(67.86%vs.46.91%,P=0.007)、肾功能衰竭(71.43%vs.46.30%,P=0.001)、肺功能衰竭(75.00%vs.54.32%,P=0.007)、多脏器功能衰竭(51.79%vs.30.86%,P=0.005)、抗菌药物使用时间≥14 d(60.71%vs.41.98%,P=0.015)、PPI使用时间≥14 d(60.71%vs.44.44%,P=0.036)、血管活性药物使用时间≥7 d(41.07%vs.25.93%,P=0.033)、行机械通气(62.50%vs.40.74%,P=0.005)及血液滤过(50.00%vs.34.57%,P=0.041)的患者比例显著高于未感染组。多因素Logistic回归分析结果显示:入院时APPACHEⅡ评分≥20分和肺功能衰竭是脓毒性休克患者并发艰难梭状芽孢杆菌感染的独立危险因素(P<0.05)。结论入院时APPACHEⅡ评分≥20分和肺功能衰竭是脓毒性休克患者并发艰难梭状芽孢杆菌感染的独立危险因素,对这类危重患者要加强监护和预防,以降低艰难梭状芽孢杆菌感染率。

Objective Clostridium difficile was a major factor leading to poor prognosis and prolonged hospital stay in critically ill patients. The present study was to investigate the clinical features of Clostridium diffieile infection in patients with septic shock. Methods From January, 2015 to December, 2016, 218 consecutive cases of patients with septic shock in our hospital were collected. According to the development of Clostridium difficile infection or not, all patients were assigned into an infection group （ n = 56 ） or a control group （ n = 162 ）. The clinical features of the both groups were compared. Results Compared with the control group, patients in the infection group got higher rates of APPACHE Ⅱ≥ 20 （57.14% vs. 31.48%, P=0.001）, laetate≥4 mmol/L （67.86% vs. 46.91%, P=0.007）, acute kidney injury （71.43% vs. 46.30%, P =0. 001 ）, acute lung injury （75.00% vs. 54.32%, P =0.007）, multiple organ failure （51.79% vs. 30.86%, P =0. 005）, antibiotics usage i〉 14 days（60.71% vs. 41.98%, P =0. 015）, proton pump inhibitor≥ 14 days（60.71% vs. 44.44%, P =0. 036）, vasoaetive drugs I〉 7 days（41.07% vs. 25.93% , P = 0. 033）, mechanical ventilation （62.50% vs. 40.74%, P =0. 005） and hemofihration （ 50.00% vs. 34.57%, P = 0. 041 ）. Multivariate logistics regression analysis revealed that APPACHE score ≥2 0 and lung failure were risk factors for Clostridium difficile infection in septic shock patients （ P 〈 0.05 ）. Conclusion APPACHE score ≥ 20 and lung failure were risk factors for Clostridium diffieile infection in septic shock patients. Intensive care and prevention should be taken to reduce the infection rate of Clostridium difficile in these critically ill patients.