腹泻患者艰难梭菌感染的调查研究

Investigation of Clostridioides difficile infection in patients with diarrhea

目的了解滨州市中心医院住院腹泻患者艰难梭菌感染(CDI)情况,从而为临床提供有效的感控措施。方法选取2019年9月至2022年5月在滨州市中心医院住院的94例腹泻患者为研究对象,采用GeneXpert法检测艰难梭菌(CD)DNA,分析其在不同临床条件下的发生情况。结果94例患者中,CD阳性56例,阳性率59.6%,其中男性33例(58.9%),女性23例(41.1%);19~<60岁年龄段的有11例(19.6%),60~90岁年龄段的有45例(80.4%);住院时间<10 d的有20例(35.7%),≥10 d的有36例(64.3%);临床诊断为结核病的有40例(71.4%),非结核病的有16例(28.6%);使用抗生素的有56例(100.0%),未使用抗生素的有0例。CD阳性、CD阴性患者的性别、年龄及住院时间比较,差异无统计学意义(P>0.05);CD阳性、CD阴性患者的临床诊断、抗生素使用情况比较,差异具有统计学意义(P<0.05)。在56例CD阳性患者中,027型阳性49例,027型阴性7例。027型阳性病例中,男性27例(55.1%),女性22例(44.9%);19~<60岁年龄段的有7例(14.3%),60~90岁年龄段的有42例(85.7%);住院时间<10 d的有16例(32.7%),≥10 d的有33例(67.3%);临床诊断为结核病的有40例(81.6%),非结核病的有9例(18.4%)。027阳性、027阴性患者的性别、住院时间比较,差异无统计学意义(P>0.05);027阳性、027阴性患者的年龄、临床诊断比较,差异具有统计学意义(P<0.05)。结论GeneXpert法检测CD具有快速、灵敏度高及特异性高的优势,可以快速帮助临床诊断CDI。腹泻患者的性别、年龄与CDI无显著关联,而有结核病、使用抗生素是CDI发生的相关影响因素。腹泻、结核病患者容易发生CDI,且为高产毒型027。因此,对于腹泻、结核病患者应加强院感控制。

Objective To understand the situation of Clostridioides difficile infection(CDI)in hospitalized diarrhea patients in Binzhou Central Hospital,so as to provide effective infection control measures for clinical practice.Methods A total of 94 patients with diarrhea who were hospitalized in Binzhou Central Hospital from September 2019 to May 2022 were selected as the research objects.The DNA of Clostridioides difficile(CD)was detected by GeneXpert method,and its occurrence under different clinical conditions was analyzed.Results Of the 94 patients,56 were CD-positive,with a positive rate of 59.6%,including 33 males(58.9%)and 23 females(41.1%);there were 11 cases(19.6%)in the age group of 19-<60 years old and 45 cases(80.4%)in the age group of 60-90 years old;there were 20 cases(35.7%)with hospitalization time<10 d and 36 cases(64.3%)with hospitalization time≥10 d;clinical diagnosis of tuberculosis in 40 cases(71.4%),non-tuberculosis in 16 cases(28.6%);there were 56 cases(100.0%)using antibiotics,and 0 cases without antibiotics.There were no significant differences in gender,age and hospitalization time between CD-positive and CD-negative patients(P>0.05);there were statistically significant differences in clinical diagnosis and antibiotic use between CD-positive and CD-negative patients(P<0.05).Among the 56 patients with CD-positive,49 case were type 027-positive and 7 cases were type 027-negative.Among the 027-positive cases,27 cases(55.1%)were males,and 22 cases(44.9%)were females;there were 7 cases(14.3%)in the age group of 19-<60 years old,and 42 cases(85.7%)in the age group of 60-90 years old;there were 16 cases(32.7%)with hospitalization time<10 d and 33 cases(67.3%)with hospitalization time≥10 d;clinical diagnosis of tuberculosis in 40 cases(81.6%),non-tuberculosis in 9 cases(18.4%).There were no significant differences in gender and hospitalization time between 027-positive and 027-negative patients(P>0.05);there were statistically significant differences in age and clinical diagnosis between 027-positive and 027-negative patients(P<0.05).Conclusion The detection of CD by GeneXpert method has the advantages of fast,high sensitivity and high specificity,which can quickly help the clinical diagnosis of CDI.The gender and age of diarrhea patients are not significantly correlated with CDI,while tuberculosis and the use of antibiotics are the related factors of CDI.CDI is prone to occur in patients with diarrhea and tuberculosis,and it is a high-yield toxin type 027.Therefore,hospital infection control should be strengthened for patients with diarrhea and tuberculosis.