重症监护室中艰难梭菌无症状携带老年患者危险因素分析

Risk factors of asymptomatic carriers of Clostridium difficile among aged patients in ICU

目的初步分析重症监护室中艰难梭菌(Clostridium difficile)无症状携带老年患者的危险因素,为制定有效的预防控制策略提供一定的理论依据。方法选取2016年11月1日-11月30日于浙江医院重症监护室住院的老年患者45例作为研究对象。采用酶联免疫荧光技术检测其粪便标本的艰难梭菌谷氨酸脱氢酶(glutamate dehydrogenase,GDH),同时将标本接种于艰难梭菌鉴定培养基(chroml D C.difficile agar,CDIF),用质谱仪鉴定菌株的菌种。结果 45例患者中,共检出艰难梭菌18株,阳性率为40.00%。艰难梭菌分离率在年龄、性别、住院史、使用抗菌药物种类以及不同基础疾病等方面差异无统计学意义(P>0.05),在有无机械通气患者中检验结果差异有统计学意义(P<0.05)。结论重症监护室中老年患者粪便标本艰难梭菌培养阳性率高,应加强对此类患者艰难梭菌的监测和筛查,其中的机械通气患者尤其需要密切关注。

Objective To primarily analyze the risk factors of asymptomatic carriers of Clostridium difficile among aged patients in ICU and to provide theoretical basis for developing effective prevention and control strategies. Methods Forty-five aged patients in ICU from Nov 1,2016 to Nov 30,2016 were selected as the study objects. The glutamate dehydrogenase（GDH） was tested qualitatively by fluorescent enzyme-linked immunoassay,and the fecal specimens were inoculated simultaneously to chroml D C. difficile agar（CDIF） for anaerobic culture,then the positive isolates were identified by mass spectrograph.Results Of 45 anal swab specimens,18 strains of C. difficile were detected,with the positive rate of 40. 00%. The isolating rate had no statistical significance on the differences of age,the gender,history of inpatient visits,use of antibiotics,duration of use of antibiotics,or basic diseases（P〈0. 05）,but there was statistical significance on the difference between patients with mechanical ventilation therapy and patients without mechanical ventilation therapy（P〈0. 05）. Conclusion The positive rate of C. difficicle is high among aged patients in ICU. It is necessary to strengthen the surveillance and screening of C. difficicle among aforementioned patients,especially the mechanically ventilated patients.