住院腹泻患者艰难梭菌感染的危险因素分析

Risk Factors of Clostridium difficile Infection in Hospitalized Patients With Diarrhea

背景:艰难梭菌感染(CDI)是医院内获得性腹泻的最常见原因,也是住院腹泻患者死亡的重要原因,对其危险因素还缺乏足够的临床研究。目的:探讨住院腹泻患者发生CDI的危险因素。方法:收集2015年1月-2019年1月河北医科大学第二医院行艰难梭菌检测的住院腹泻患者230例,并分为CDI组和非CDI组,采用Logistic回归分析探讨CDI的危险因素。结果:与非CDI组相比,CDI组患者住院时间延长,过去6个月内进行手术的比例升高,差异有统计学意义(P<0.05)。CDI组患者共病数量高于非CDI组(P<0.05);CDI组中胃肠道疾病、心血管疾病、血液/免疫系统疾病、神经系统疾病比例高于非CDI组,差异有统计学意义(P<0.05)。多因素分析显示共病数量(OR=3.215,95%CI:1.576~4.743;P=0.003)、胃肠道疾病(OR=4.135,95%CI:3.048~11.416;P=0.000)、外科手术史(OR=6.734,95%CI:2.692~15.849;P=0.000)以及抗菌药物使用(OR=5.996,95%CI:2.173~15.481;P=0.000)是CDI的危险因素,尤其是喹诺酮类抗菌药物的使用(OR=4.769,95%CI:2.138~14.757;P=0.000)。结论:CDI会延长腹泻患者住院时间;共病数量、有胃肠道基础疾病、近期有外科手术史以及抗菌药物尤其是喹诺酮类抗菌药物的使用是住院腹泻患者发生CDI的危险因素。

Background: Clostridium difficile infection(CDI) is the most common cause of hospital-acquired diarrhea and an important cause of death in hospitalized patients with diarrhea. However, there are not sufficient clinical researches on the risk factors of CDI. Aims: To investigate the risk factors of CDI in hospitalized patients with diarrhea. Methods: A total of 230 hospitalized diarrhea patients who received Clostridium difficile test from January 2015 to January 2019 at the Second Hospital of Hebei Medical University were collected. The patients were divided into CDI group and non-CDI group. Logistic regression analysis was performed to investigate the risk factors of CDI. Results: Compared with non-CDI group, patients in CDI group had a longer hospital stay(P<0.05) and a higher proportion of surgery in the past 6 months(P<0.05). The number of comorbidities in CDI group was higher than that in non-CDI group(P<0.05), and the ratio of gastrointestinal disease, cardiovascular disease, blood/immune system disease, nervous system disease in CDI group were higher than those in non-CDI group(P<0.05). Multivariate analysis showed the number of comorbidities(OR=3.215, 95% CI: 1.576-4.743;P=0.003), gastrointestinal disease(OR=4.135, 95% CI: 3.048-11.416;P=0.000), surgical history(OR=6.734, 95% CI: 2.692-15.849;P=0.000) and antibiotic use(OR=5.996, 95% CI: 2.173-15.481;P=0.000) were risk factors of CDI, especially the use of quinolone antibiotics(OR=4.769, 95% CI: 2.138-14.757;P=0.000). Conclusions: CDI can prolong the hospital stay of patients with diarrhea. Number of comorbidities, underlying gastrointestinal disease, recent history of surgery and antibiotic use, especially the use of quinolone antibiotics are risk factors of CDI in hospitalized patients with diarrhea.