炎症性肠病艰难梭菌感染危险因素与耐药特点

Risk factors and drug resistance characteristics of Clostridium difficile infection in patients with inflammatory bowel disease

目的探讨炎症性肠病(IBD)患者艰难梭菌(CDI)感染危险因素、耐药性特点及毒素蛋白A/B表达。方法选择儋州市人民医院消化内科2017年9月-2020年9月收治为IBD[包括溃疡性结肠炎(UC)和克罗恩病(CD)]的患者120例作为研究对象,根据患者是否合并CDI感染将其分为CDI组和非CDI组。通过电子病历调查的方式统计研究对象一般资料和实验室检查结果,包括性别、年龄、疾病类型、临床类型、严重程度、近1月应用抗菌药物、免疫抑制剂、质子泵抑制剂、非甾体抗炎药和查尔斯共病指数评分。使用VITEK-2 Compact全自动微生物鉴定系统进行耐药性分析。采用聚合酶链式扩增反应(PCR)和酶联免疫吸附法(ELISA)检测CDI阳性情况。结果多元Logistic回归分析结果表明,近1月应用抗菌药物、免疫抑制剂、质子泵抑制剂、查尔斯共病指数评分是影响IBD合并CDI的独立危险因素(P<0.05);26株临床分离的CDI对替加环素、甲硝唑、万古霉素耐药率均为0,对左氧氟沙星、环丙沙星、阿莫西林/克拉维酸、莫西沙星耐药率分别为50.00%、96.15%、3.85%、42.31%;26株检出艰难梭菌共包括产毒菌24株,检出率92.31%,其中毒素蛋白A+毒素蛋白B+型20株,毒素蛋白A-毒素蛋白B+型4株,毒素蛋白A+毒素蛋白B-型0株。结论IBD患者并发CDI感染与近1月应用抗菌药物、免疫抑制剂、质子泵抑制剂、查尔斯共病指数评分有关,替加环素、甲硝唑和万古霉素可用于临床治疗。

OBJECTIVE To explore the risk factors for Clostridium difficile(CDI)infection,the characteristics of drug resistance and the expression of toxin protein A/B in patients with inflammatory bowel disease(IBD).METHODS A total of 120 patients with IBD(including UC and CD)admitted to the Department of Gastroenterology,Danzhou People's Hospital from Sep 2017 to Sep 2020 were recruited as the research subjects,and the patients were divided into the CDI group and non-CDI group according to whether they had CDI infection.The general information and laboratory test results of all patients were collected by using electronic medical record surveys,including genders,age,disease types,clinical types,severity,use of antibacterial drugs,immunosuppressants,proton pump inhibitors,and non-steroids anti-inflammatory drugs,and Charles Comorbidimia Index score in the past month.VITEK-2 Compact automatic microbial identification system was used for drug resistance analysis.Polymerase chain amplification reaction(PCR)and enzyme-linked immunosorbent assay(ELISA)were used to detect the positive status of CDI.RESULTS Multivariate Logistic regression analysis showed that the use of antibacterial drugs,immunosuppressants,proton pump inhibitors,and Charles comorbidity index scores in the past month were independent risk factors for IBD and CDI(P<0.05).Drug resistant rates of 26 clinically isolated CDI strains to tigecycline,metronidazole,and vancomycin were all 0,and with the resistant rate to levofloxacin,ciprofloxacin,amoxicillin/carat of 50.00%,96.15%,3.85%and 42.31%,respectively.Twenty-six strains of C.difficile were detected,including 24 strains of toxigenic bacteria,with the detection rate of 92.31%,of which 20 strains were toxin protein A+toxin protein B+type,4 strains were toxin protein A-toxin protein B+type and no strain was toxin protein A+toxin protein B-type.CONCLUSION Patients with IBD combined with CDI infection is related to the use of antibacterial drugs,immunosuppressants,proton pump inhibitors,as well as Charles comorbidity index scores in the past month.Tigecycline,metronidazole and vancomycin can be used in clinical treatment.