ICU老年HA-CDI患者的临床特征、肠道菌群状况及干预对策研究

Study on clinical characteristics, intestinal flora and intervention strategies of elderly patients with HA-CDI in ICU

目的研究重症监护病房(intensive care unit,ICU)老年医院获得性艰难梭菌感染(hospital-acquired Clostridium difficile infection,HA-CDI)患者的临床特征、肠道菌群情况及干预对策。方法选取2019年3月至2022年3月杭州市第一人民医院城北院区ICU收治的150例老年患者,根据艰难梭菌定性检测结果将其分为HA-CDI组(n=30)和非HA-CDI组(n=120)。比较两组患者的年龄、性别、基础疾病、治疗用药情况、实验室指标、ICU住院时间等临床特征;收集患者的新鲜粪便,接种培养后观察并记录两组患者的肠道菌群情况。结果HA-CDI组患者的糖尿病比例、使用质子泵抑制剂比例、白细胞计数、血钾水平均显著高于非HA-CDI组,白蛋白水平显著低于非HA-CDI组(P<0.05)。HA-CDI组患者的拟杆菌、梭菌菌落数量均显著多于非HA-CDI组,双歧杆菌及肠球菌菌落数量均显著少于非HA-CDI组(P<0.05)。结论ICU老年HA-CDI患者的糖尿病比例、使用质子泵抑制剂比例较高,且存在肠道菌群失衡现象。

Objective To study the clinical features,intestinal flora and intervention strategies of elderly hospital-acquired Clostridium difficile infection(HA-CDI)patients in intensive care unit(ICU).Methods A total of 150 elderly patients were selected from the ICU of Chengbei District,Hangzhou First People’s Hospital from March 2019 to March 2022.According to the qualitative detection results of Clostridium difficile,they were divided into HA-CDI group(n=30)and non-HA-CDI group(n=120).The clinical characteristics of two groups of patients,including age,gender,underlying diseases,treatment medication status,laboratory indicators,and ICU hospitalization time were compared.The fresh feces of patients were collected,the gut microbiota of the two groups of patients after inoculation and culture were observed and recorded.Results The proportion of diabetes mellitus,the proportion of proton pump inhibitor use,white blood cell count and blood potassium level in HA-CDI group were significantly higher than those in non-HA-CDI group,and the albumin level was significantly lower than that in non-HA-CDI group(P<0.05).The colonies of Bacteroides and Clostridium in HA-CDI group were significantly higher than those in non-HA-CDI group,and the colonies of Bifidobacterium and Enterococcus were significantly lower than those in non-HA-CDI group(P<0.05).Conclusion The proportion of diabetes mellitus and proton pump inhibitor are higher in elderly HA-CDI patients in ICU,and there is an imbalance of intestinal flora.