机械通气患者艰难梭状芽孢杆菌感染危险因素及预后分析

Risk factors and prognosis of Clostridium difficile infection in patients undergoing mechanical ventilation

目的探讨机械通气患者艰难梭状芽孢杆菌感染的危险因素,并分析其预后,为临床预防及治疗提供理论依据。方法自2017年1月至2017年12月,连续性收集无锡市第二人民医院收治的机械通气患者382例,常规进行艰难梭状芽孢杆菌检测,共49例患者发生艰难梭状芽孢杆菌感染,分析不同临床特征患者艰难梭状芽孢杆菌感染率及危险因素,同时使用多因素回归分析探讨艰难梭状芽孢杆菌感染对患者院内死亡的影响。结果使用抗生素≥3种、急性生理功能与慢性健康状况评分系统Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分≥20分、序贯器官衰竭评估(sequential organ failure assessment,SOFA)评分≥4分、机械通气时间≥14天、多器官功能衰竭、质子泵抑制剂使用时间≥14天、住院天数≥30天及死亡的患者艰难梭状芽孢杆菌感染率均显著升高(P_均<0.05)。多因素Logistic回归分析显示:APACHEⅡ评分≥20分、死亡、多器官功能衰竭、使用抗生素≥3种、机械通气时间≥14天是导致机械通气患者艰难梭状芽孢杆菌感染的危险因素(P_均<0.05)。多因素Logistic回归分析显示艰难梭状芽孢杆菌感染是机械通气患者院内死亡的危险因素(P<0.05)。结论机械通气患者艰难梭状芽孢杆菌感染率较高,可导致患者院内死亡率升高,应常规检测并加强干预。

ObjectiveTo investigate the risk factors and prognosis of Clostridium difficile infection in patients undegoing mechanical ventilation. MethodFrom January 2017 to December 2017, 382 consecutive patients with mechanical ventilation in Wuxi Second People＇s Hospital were collected. Clostridium diffcile infection was routinely detected in these patients, and a total of 49 cases developed Clostridium diffcile infection. The Clostridium diffcile infection rate in patients with different clinical features and the risk factors of Clostridium difficile infection in patients with mechanical ventilation were studied as well. Moreover, the multi-variate regression analysis was used to analyze the inffuence of Clostridium diffcile infection on mortality. ResultPatients with antibiotics usage ≥ 3 kinds, acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） score ≥ 20 points, sequential organ failure assessment （SOFA） score ≥ 4 points, mechanical ventilation time ≥ 14 days, multiple organ failure, proton pump inhibitor usage time≥ 14 days, hospital day≥ 30 days and death got an elevated level of Clostridium diffcile infection （Pall〈0.05）. APACHE Ⅱ score ≥ 20 points, death, multiple organ failure, antibiotics usage ≥ 3 kinds, mechanical ventilation time ≥ 14 days were the risk factor of Clostridium difficile infection in patients undergoing mechanical ventilation （Pall〈 0.05）. Multi-variate Logistic regression analysis showed that Clostridium diffcile infection was a risk factor for in-hospital mortality in mechanically ventilated patients （P 〈 0.05）. ConclusionThe infection rate of Clostridium diffcile in mechanically ventilated patients is higher, which can lead to higher hospital mortality. Routine testing and intervention should be strengthened.