艰难梭菌感染的危险因素分析

Risk factors and analysis of Clostridium difficile infections

目的探讨艰难梭菌感染的危险因素,为制定有效的预防与控制措施提供理论依据。方法2016年10月-2017年2月,收集呼吸内科、感染科和消化内科住院患者新鲜大便标本300份,用选择性培养基进行厌氧培养,并用艰难梭菌检测经典二步法检测毒素,同时收集所有患者的临床资料和实验室指标,进行艰难梭菌感染危险因素分析;采用SPSS 18.0软件进行统计分析。结果共有谷氨酸脱氢酶(GDH)阳性86例(28.6%),其中毒素A/B阳性27例(9.0%)。GDH阳性患者中,年龄>65岁的有40例(46.5%),男性患者62例(72.1%),使用质子泵抑制剂有49例(56.9%),有抗生素使用史55例(63.9%)。对艰难梭菌产毒株和非产毒株感染患者的临床特征进行单因素分析显示,GDH值、年龄、白细胞计数、C-反应蛋白、中性粒细胞比例、血肌酐、体温两者之间差异有统计学意义(P<0.05);多因素Logistic回归分析显示只有GDH值差异有统计学意义(P<0.05)。结论本院住院患者非产毒艰难梭菌定植率高,炎症指标对艰难梭菌是否产毒具有一定提示作用,高GDH值提示菌株产毒可能。无症状携带患者更值得关注。

Objective To investigate the risk factors of Clostridium difficile infection,and to provide theoretical basis for effective prevention and control measures.Methods From October 2016 to February 2017,300 fresh stool samples were collected from patients who were hospitalized in Respiratory Department,Infectious Department and Digestive Department;specimens were cultured anaerobically by selective medium and tested with the classical two step assay to detect Clostridium difficile;the clinical data and laboratory indexes were also collected from patients,and the risk factors of Clostridium difficile infection were analyzed;SPSS 18.0 software was used for statistical analysis.Results Glutamate dehydrogenase(GDH)was positive in 86 patients(28.6%),of which 27 were positive for toxin A&B(9.0%).Among the GDH positive patients,there were 40 patients(46.5%)who were older than 65;in 62 males(72.1%),49 underwent proton pump inhibitors(56.9%),and 55 underwent antibiotics(63.9%).The single factor analysis showed that there was statistical significance on the differences in the GDH value,age,white blood cell count,C-reaction protein,neutrophil percentage,serum creatinine,and temperature between toxigenic and non-toxigenic Clostridium difficile infection patients(P<0.05),but multivariate Logistic regression analysis shows that only GDH value is statistically significant(P<0.05).Conclusion It is of high colonization rate of non-toxigenic Clostridium difficile in our hospital,and the inflammatory indexes may be helpful to the production of Clostridium difficile.The high GDH value suggested whether the strain was toxigenic or not,and asymptomatic carriers deserve more attention.