北京地区抗生素相关性腹泻住院患者发生艰难梭菌相关性腹泻的影响因素分析

Analysis of influencing factors of clostridium difficile-diarrhea associated diarrhea in hospitalized patients with antibiotic-associated diarrhea in Beijing

目的探讨北京地区抗生素相关性腹泻(antibiotic-associated diarrhea,AAD)住院患者艰难梭菌相关性腹泻(clostridium difficile associated diarrhea,CDAD)的现状及其影响因素。方法选取2022年7月至2023年7月北京9家医院近1年内就诊的AAD住院患者157例,将患者分为CDAD组(34例)和非CDAD组(123例)。采用多因素logistic回归方程分析北京AAD住院患者发生CDAD的影响因素。结果157患者中男79例,女78例,年龄18~94岁,平均(72.8±14.7)岁。CDAD发生率为21.7%(34/157),13例谷氨酸脱氢酶抗原检测结果阳性,毒素检测阴性,进一步行PCR检测和肠镜检查诊断CDAD,漏诊率为38.2%(13/34)。多因素logistic分析结果显示,BMI越小(OR=0.833,95%CI:0.733~0.947,P=0.005)、腹泻前抗生素使用天数越长(OR=1.065,95%CI:1.016~1.115,P=0.008)的患者更容易发生CDAD。结论北京地区AAD住院患者CDAD发生率为21.7%,单独依靠毒素检测漏诊率高达38.2%。BMI和腹泻前抗生素使用天数为AAD住院患者发生CDAD的独立风险因素,CDAD的临床表现更重。

Objective To explore the current situation and influencing factors of clostridium difficile associated diarrhe(CDAD)in hospitalized patients with antibiotic-associated diarrhea(AAD)in Beijing.Methods A total of 157 patients with AAD who were admitted to nine hospitals in Beijing from July 2022 to July 2023 were selected,and were divided into CDAD group(34 cases)and non-CDAD group(123 cases).The influencing factors of CDAD in hospitalized patients with AAD in Beijing was analyzed by multivariate logistic regression.Results Among the 157 patients,there were 79 males and 78 females,aged from 18 to 94 years,with an average of(72.8±14.7)years.The incidence of CDAD was 21.7%(34/157),13 cases were positive for glutamic acid dehydrogenase antigen and negative for toxin,and the missed diagnosis rate was 38.2%(13/34)by further PCR detection and colonoscopy.Multivariate logistic analysis showed that patients with lower BMI(OR=0.833,95%CI:0.733-0.947,P=0.005)and longer days of antibiotic use before diarrhea(OR=1.065,95%CI:1.016-1.115,P=0.008)were more likely to develop CDAD.Conclusions The incidence of CDAD in hospitalized patients with AAD in Beijing is 21.7%,and the missed diagnosis rate of relying solely on toxin detection is as high as 38.2%.BMI and days of antibiotic use before diarrhea are independent risk factors for CDAD in AAD inpatients,and the clinical manifestations of CDAD are more serious.