血液病患者产毒素艰难梭菌定植的危险因素分析

Analysis of the Risk Factors of Toxigenic Clostridium Difficile Colonizatio in Patients With Hematological Diseases

目的对医院血液科病区产毒素艰难梭菌定植(toxigenic Clostridium difficile colonizatio,tCDC)的危险因素进行分析,为临床艰难梭菌感染(Clostridium difficile infection,CDI)的诊治和防控提供依据。方法收集2019年1月—2022年6月263例福建医科大学附属第一医院住院血液病患者的粪便标本,随机抽取研究期间任意3个月医院检验科内各科室的住院患者送检资料,以反映2019年1月—2022年6月医院整体的CDI状况。对血液科住院患者进行tCDC的横断面调查,采集粪便标本进行艰难梭菌(Clostridium difficile,CD)抗原及毒素A/B的检测,对CDI感染状况进行检测;收集患者临床信息,分析tCDC的危险因素。结果研究期间任意3个月内各科室住院患者送检标本,血液科CD抗原阳性率最高。研究263例血液病患者中,女性居多,占比51.0%,平均年龄(55.32±17.22)岁,平均住院天数(18.35±16.24)d;以弥漫大B细胞淋巴瘤、淋巴瘤以及多发性骨髓瘤为主要类型;55例患者检测出CD抗原阳性,其中,14例艰难梭菌抗原和毒素都为阳性,为产毒素艰难梭菌感染(toxigenic Clostridium difficile infection,tCDI)。对收集tCDC的因素进行单因素分析,其中年龄(>60岁)、化疗、激素、抗生素纳入tCDI的危险因素进一步行Logistic回归分析,结果显示,年龄(>60岁)、抗生素为tCDI的独立危险因素(P<0.05)。结论血液病患者tCDC发生率较高,年龄(>60岁)和抗生素的使用是tCDC的独立危险因素,此文的研究结果为后期指导CDI防控标准制定提供了借鉴内容。

Objective To analyze the risk factors of toxigenic Clostridium difficile colonizatio(tCDC)in the department of hematology,so as to provide the basis for the diagnosis,treatment and prevention of clinical Clostridium difficile infection(CDI).Methods The stool samples of 263 hospitalized patients with hematological diseases from January 2019 to June 2022 in the First Affiliated Hospital of Fujian Medical University were collected,and the data of hospitalized patients from various departments in the laboratory of the hospital in any three months during the study period were randomly selected to reflect the overall CDI situation of the hospital from January 2019 to June 2022.A cross-sectional survey of tCDC was carried out in hospitalized patients in hematology department.Fecal samples were collected for Clostridium difficile(CD)antigen and toxin A/B detection,and CDI was detected.The clinical information was collected and the risk factors of tCDC were analyzed.Results During the study period within three months in the hospital patient samples,CD antigen positive rate was highest in hematology department.263 patients with hematological diseases received tCDC cross-sectional survey,female patients accounted for 51.0%,the average age was(55.32±17.22)years old,the average hospitalization days was(18.35±16.24)days;diffuse large B-cell lymphoma,multiple myeloma and multiple myeloma were the main disease types.CD antigen of 55 patients were tested positive,and CD toxin of 14 patients were positive among them.These 14 patients were toxigenic Clostridium difficile infection(tCDI).Univariate analysis was performed on the factors collected for tCDC.Age(>60 years old),chemotherapy,hormone and antibiotics were included in the risk factors of tCDI,and then Logistic regression analysis showed that age(>60 years old)and antibiotics were independent risk factors for tCDC(P<0.05).Conclusion The incidence of tCDC is high in patients with blood diseases.Age(>60 years old)and antibiotic use are independent risk factors for tCDC.The results of this research for the late to guide CDI control standard provides reference content.