医院获得性艰难梭菌感染临床诊疗现状研究

Current status of diagnosis and treatment of hospital-acquired Clostridioides difficile infection

目的了解医疗机构医院获得性艰难梭菌感染(Clostridium difficile infection,CDI)诊疗现状,为提高疾病防治水平提供实践依据。方法回顾性分析南京医科大学第一附属医院2017年1月1日-2018年12月31日期间52例医院获得性CDI病例的基本资料、治疗方法及预后情况;采用调查问卷方式了解医生对艰难梭菌感染知识的掌握现状。结果连续两年共诊断52例医院获得性CDI病例,其中>60岁老年患者占69.23%;以感染严重程度分级,轻-中度感染患者占76.92%;感染前30 d内,使用的抗菌药物主要为抗真菌类、头孢3代和碳青霉烯类;28例53.85%轻-中度和重症感染患者未进行抗CDI治疗。对70名感控医生进行CDI知识问卷调查,有效回收51份调查表,回收率72.86%,仅有14名占27.45%的医生对住院腹泻患者考虑CDI,医生送检医嘱开立知晓率33.33%、CDI诊断标准知晓率5.88%、CDI治疗方案知晓率15.69%。结论医院获得性CDI以轻-中度感染患者为主,预后较好;临床医生对艰难梭菌感染认知有较为明显欠缺,应提高其艰难梭菌感染诊疗能力。

OBJECTIVE To understand the status of diagnosis and treatment of hospital-acquired Clostridioides difficile infection(CDI)in medical institutions,and to provide practical basis for the improvement level of prevention and treatment.METHODS The basic data,treatment and prognosis in 52 cases with hospital-acquired CDI in the first affiliated hospital of Nanjing medical university from Jan 1 st,2017 to Dec 31 th,2018 were retrospectively analyzed.RESULTS Fifty-two cases with hospital-acquired CDI were diagnosed in two consecutive years,69.23%were elderly patients over 60 years of age.Patients with mild to moderate infection accounted for 76.92%according to the severity of infection.The top three antibiotics used were antifungal agents,cephalosporins and carbapenems 30 days before the infection occurred.Twenty-eight(53.85%)patients with mild to moderate and severe infection did not receive the anti-C.difficile treatment.A questionnaire survey about CDI was conducted among 70 doctors in infection control department and 51 doctors were answered,with the recovery rate of 72.86%.Only 14 physicians(27.45%)considered CDI for patients with diarrhea,the awareness rate of diagnostic criteria was 5.88%,the awareness rate of prescription was 33.33%,and the awareness rate of treatment standard for CDI was 15.69%.CONCLUSION Nosocomial C.difficile infection mainly occured in patients with mild to moderate infection,and the prognosis was good.Physicians lack knowledge of CD,and their ability to diagnose and treat CDI should be improved.