老年住院患者艰难梭菌感染的调查性研究
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摘要
目的通过检测住院老年患者粪便标本中的艰难梭菌毒素,分析其阳性发生率与其他临床各项指标和因素的相关关系,进而探索住院老年患者艰难梭菌感染发生的可能危险因素,为临床采取积极有效的相关感染防控措施提供一定基础。方法纳入60例65岁以上的老年住院腹泻患者作为研究对象,采用酶联荧光免疫分析(ELFA)法对患者粪便中的艰难梭菌毒素A/B进行定性检测,根据检测结果将患者分为艰难梭菌相关性腹泻阳性组和阴性组,分析年龄、住院时间、抗生素使用情况、鼻饲或质子泵抑制剂治疗与否、慢性病种类、白蛋白水平、中性粒细胞比例等因素,采用SPSS22.0软件对各因素进行统计学处理,分析CDAD阳性患者临床特征及发生的危险因素。结果 60例老年住院患者中有18例艰难梭菌毒素检出,阳性率为30%,其中17例来自内科病区。18例CDAD阳性患者中,6例为鼻饲营养,4例接受质子泵抑制剂治疗。阳性患者均使用过头孢类、碳青霉素类、喹诺酮类等抗生素,15例为混用抗生素。艰难梭菌感染阳性组白蛋白水平均值为31.9±3.4g/L,显著低于阴性组水平,差异具有统计学意义。合并的慢性病发生种类数都对CDAD的发生影响有统计学意义。结论抗生素的使用是艰难梭菌感染的危险因素,合并慢性病及接受鼻饲及质子泵抑制剂治疗的老龄患者,由于免疫力低下,较其他人群更易感染艰难梭菌,对于此类患者,应尤其注意抗生素的使用及院内感染的控制。
Objective This study was to investigate the prevalence of Clostridium difficile in the elderly inpatients and its correlation with several clinical parameters and factors via analyzing bacterial toxin in patient feces. To explore the possible risk factors of Clostridium difficile infection for these patients,and to provide data for clinicians to take better and more effective care in infection control measures. Methods Sixty older than 65 year old elderly inpatients were randomly chosen as the research subjects. Enzyme-linked fluorescent assay( ELFA) was employed to qualitatively detect the toxin A / B of Clostridium difficile. Based on the ELFA results,the research subjects were divided into 2 groups,Clostridium difficile associated diarrhea( CDAD) positive and negative groups. Several clinical parameters,such as age,hospitalization length,antibiotics information,whether or not nasal feeding and proton pump inhibitor therapy were used. Chronic diseases,albumin level and neutrophils proportion,were analyzed. The software SPSS 22. 0 was employed for statistics to analyze the clinical features and risk factors for the CDAD positive inpatients. Results Eighteen of 60 elderly inpatients were detected positively; positive occurrence was 30%,17 of them were hospitalized in internal medicine ward. Of 18 CDAD positive inpatients,6 received nasal feeding,4 received proton pump inhibitor therapy. All 18 CDAD positive inpatients received antibiotic care,such as cephalosporins,carbon penicillins,or quinolones; 15 were administrated more than one antibiotic. The mean of albumin level of Clostridium difficile positive group was 31. 9 ± 3. 4g / L,which was significantly lower than negative group. The types of chronic comorbidities were considered to produce the statistical significance for theoccurrence of CDAD. Conclusion The antibiotic abuse was considered to be the risk factor of Clostridium difficile infection. The elderly patients,who suffered from chronic comorbidities and received nasal feeding or proton pump inhibitor therapy,due to the poor immunity,were more vulnerable to Clostridium difficile infection. Therefore,the antibiotics should be used in a very prudent way and nosocomial infection should be under effective control,especially for these elderly.
Objective This study was to investigate the prevalence of Clostridium difficile in the elderly inpatients and its correlation with several clinical parameters and factors via analyzing bacterial toxin in patient feces. To explore the possible risk factors of Clostridium difficile infection for these patients,and to provide data for clinicians to take better and more effective care in infection control measures. Methods Sixty older than 65 year old elderly inpatients were randomly chosen as the research subjects. Enzyme-linked fluorescent assay( ELFA) was employed to qualitatively detect the toxin A / B of Clostridium difficile. Based on the ELFA results,the research subjects were divided into 2 groups,Clostridium difficile associated diarrhea( CDAD) positive and negative groups. Several clinical parameters,such as age,hospitalization length,antibiotics information,whether or not nasal feeding and proton pump inhibitor therapy were used. Chronic diseases,albumin level and neutrophils proportion,were analyzed. The software SPSS 22. 0 was employed for statistics to analyze the clinical features and risk factors for the CDAD positive inpatients. Results Eighteen of 60 elderly inpatients were detected positively; positive occurrence was 30%,17 of them were hospitalized in internal medicine ward. Of 18 CDAD positive inpatients,6 received nasal feeding,4 received proton pump inhibitor therapy. All 18 CDAD positive inpatients received antibiotic care,such as cephalosporins,carbon penicillins,or quinolones; 15 were administrated more than one antibiotic. The mean of albumin level of Clostridium difficile positive group was 31. 9 ± 3. 4g / L,which was significantly lower than negative group. The types of chronic comorbidities were considered to produce the statistical significance for theoccurrence of CDAD. Conclusion The antibiotic abuse was considered to be the risk factor of Clostridium difficile infection. The elderly patients,who suffered from chronic comorbidities and received nasal feeding or proton pump inhibitor therapy,due to the poor immunity,were more vulnerable to Clostridium difficile infection. Therefore,the antibiotics should be used in a very prudent way and nosocomial infection should be under effective control,especially for these elderly.
引文
[1]Christoph L,Endres J,Lutz V M,et al.Clostridium difficile infection:guideline-based diagnosis and treatment.Dtsch Arztebl Int,2014,111(43):723-731.
[2]卢艳玲,靳会娟.艰难梭菌腹泻及实验室诊断.河南预防医学杂志,2013,24(5):391-392.
[3]刘元元,刘文恩,简子娟,等.住院腹泻患者艰难梭菌检测与分析.中国感染控制杂志,2012,11(4):293-296.
[4]甘泳江,海静如.艰难梭状芽胞杆菌相关感染的治疗进展.医学综述,2012,18(18):3006-3008.
[5]杨靖,李雅静,温海楠,等.艰难梭菌感染实验室诊断方法的研究进展.中华检验医学杂志,2012,35(8):692-696.
[6]Bouwknegt M,van Dorp S,Kuijper E.Burden of Clostridium difficile infection in the United States.N Engl J Med,2015,372(24):2368.
[7]Hampton T.Report reveals scope of US antibiotic resistance threat.JAMA,2013,310(16):1661-1663.
[8]Wu X,Hurdle J G.The Clostridium difficile proline racemase is not essential for early logarithmic growth and infection.Can J Microbiol,2014,60(4):251-254.
[9]Kenneley I L.Clostridium difficile infection is on the rise.Am J Nurs,2014,114(3):62-67.
[10]Honda H,Dubberke E R.The changing epidemiology of Clostridium difficile infection.Curr Opin Gastroenterol,2014,30(1):54-62.
[11]Djuretic T,Wall P G,Brazier J S.Clostridium difficile update on its epidemiology and role in hospital outbreaks in England and Wales.J Hosp Infect,1999,41(3):213-218.
[12]Dhawan B,Chaudhry R,Sharma N.Incidence of Clostridium difficile infection:a prospective study in an Indian hospital.J Hosp Infect,1999,43(4):275-280.
[13]Butterworth S A,Koppert E,Clarke A,et al.Recent trend in diagnosis and treatment of Clostridium difficile in a tertiary care facility.Am J Surg,1998,175(5):403-407.
[14]潘君素,梁军兵,李隆祥,等.老年患者发生艰难梭菌相关性腹泻的调查.中华医院感染学杂志,2013,23(21):5176-5177.
[15]金慧,吴建浓,韦凌娅,等.艰难梭菌分离培养与病原分子学特征研究.浙江预防医学,2014,26(6):602-603.
[16]高燕婷,章黎华,王栗,等.住院腹泻患者艰难梭菌感染的临床特点分析.上海交通大学学报(医学版),2014,34(10):1481-1486.
[17]Larson K C,Belliveau P P,Spooner L M.Tigecycline for the treatment of severe Clostridium difficile infection.Ann Pharmacother,2011,45(7-8):1005-1010.
[18]杨雪妹,吴允孚.艰难梭菌的生物学特性与实验室诊断.中国感染与化疗杂志,2013,13(3):232-234.
[19]Kelly C P,Kyne L.The host immune response to Clostridium difficile.J Med Microbiol,2011,60(Pt8):1070-1079.
[20]马坚,俞万钧,彭卫东,等.艰难梭菌感染复发的临床预测与危险因素荟萃分析.中华医学感染杂志,2015,25(11):2520-2523.
[21]白驹,雷雨婷,张吉波.艰难梭菌相关性腹泻的临床特点分析和防治策略.中外医学研究,2013,11(25):1-3.
[22]Kyne L,Sougioultzis S,Mc Farland L V,et al.Underlying disease severity as a major risk factor for nosocomial Clostridium difficile diarrhea.Infect Control Hosp Epidemiol,2002,23(11):653-659.
[2]卢艳玲,靳会娟.艰难梭菌腹泻及实验室诊断.河南预防医学杂志,2013,24(5):391-392.
[3]刘元元,刘文恩,简子娟,等.住院腹泻患者艰难梭菌检测与分析.中国感染控制杂志,2012,11(4):293-296.
[4]甘泳江,海静如.艰难梭状芽胞杆菌相关感染的治疗进展.医学综述,2012,18(18):3006-3008.
[5]杨靖,李雅静,温海楠,等.艰难梭菌感染实验室诊断方法的研究进展.中华检验医学杂志,2012,35(8):692-696.
[6]Bouwknegt M,van Dorp S,Kuijper E.Burden of Clostridium difficile infection in the United States.N Engl J Med,2015,372(24):2368.
[7]Hampton T.Report reveals scope of US antibiotic resistance threat.JAMA,2013,310(16):1661-1663.
[8]Wu X,Hurdle J G.The Clostridium difficile proline racemase is not essential for early logarithmic growth and infection.Can J Microbiol,2014,60(4):251-254.
[9]Kenneley I L.Clostridium difficile infection is on the rise.Am J Nurs,2014,114(3):62-67.
[10]Honda H,Dubberke E R.The changing epidemiology of Clostridium difficile infection.Curr Opin Gastroenterol,2014,30(1):54-62.
[11]Djuretic T,Wall P G,Brazier J S.Clostridium difficile update on its epidemiology and role in hospital outbreaks in England and Wales.J Hosp Infect,1999,41(3):213-218.
[12]Dhawan B,Chaudhry R,Sharma N.Incidence of Clostridium difficile infection:a prospective study in an Indian hospital.J Hosp Infect,1999,43(4):275-280.
[13]Butterworth S A,Koppert E,Clarke A,et al.Recent trend in diagnosis and treatment of Clostridium difficile in a tertiary care facility.Am J Surg,1998,175(5):403-407.
[14]潘君素,梁军兵,李隆祥,等.老年患者发生艰难梭菌相关性腹泻的调查.中华医院感染学杂志,2013,23(21):5176-5177.
[15]金慧,吴建浓,韦凌娅,等.艰难梭菌分离培养与病原分子学特征研究.浙江预防医学,2014,26(6):602-603.
[16]高燕婷,章黎华,王栗,等.住院腹泻患者艰难梭菌感染的临床特点分析.上海交通大学学报(医学版),2014,34(10):1481-1486.
[17]Larson K C,Belliveau P P,Spooner L M.Tigecycline for the treatment of severe Clostridium difficile infection.Ann Pharmacother,2011,45(7-8):1005-1010.
[18]杨雪妹,吴允孚.艰难梭菌的生物学特性与实验室诊断.中国感染与化疗杂志,2013,13(3):232-234.
[19]Kelly C P,Kyne L.The host immune response to Clostridium difficile.J Med Microbiol,2011,60(Pt8):1070-1079.
[20]马坚,俞万钧,彭卫东,等.艰难梭菌感染复发的临床预测与危险因素荟萃分析.中华医学感染杂志,2015,25(11):2520-2523.
[21]白驹,雷雨婷,张吉波.艰难梭菌相关性腹泻的临床特点分析和防治策略.中外医学研究,2013,11(25):1-3.
[22]Kyne L,Sougioultzis S,Mc Farland L V,et al.Underlying disease severity as a major risk factor for nosocomial Clostridium difficile diarrhea.Infect Control Hosp Epidemiol,2002,23(11):653-659.