艰难梭菌核糖体分型及腹泻发病危险因素研究  

PCR ribotype profiles of Clostridium difficile and risk factors of Clostridium difficile-associated diarrhea

作　　者：杨富英[1] 李萍[2] 李永强[2] 

机构地区：[1]广州市第一人民医院护理部,广东广州510180 [2]广州市第一人民医院消化内科,广东广州510180

出　　处：《护理学杂志》2012年第17期1-3,共3页

基　　金：广东省医学科研基金项目(A2011479);2011年度广州市医药卫生科技项目(201102A213101)

摘　　要：目的探讨艰难梭菌相关性腹泻(CDAD)发病危险因素及进行艰难梭菌核糖体分型,为针对性防护提供依据。方法选取449例抗生素相关性腹泻患者,其中92例诊断为CDAD;采用Logistic回归分析筛选CDAD发病危险因素;厌氧菌培养艰难梭菌再行PCR核糖体分型。结果CDAD发病的危险因素是鼻饲,多种慢性病,高APACHEⅡ评分,高超敏C反应蛋白,应用第三代头孢菌素、喹诺酮类抗生素及联用抗生素;使用糖肽类、硝基咪唑类抗生素降低CDAD发病(P<0.05,P<0.01)。20株艰难梭菌分为5个亚型即GZⅠ～GZⅣ型,其中GZⅢ型8株。结论住院患者CDAD发病率较高,需针对危险因素进行防护。Objective To investigate risk factors of Clostridium difficile-associated diarrhea （CDAD）, to explore PCR ribotype profiles of Clostridium difficile, and to provide empirical evidence for prevention of CDAD. Methods Among 449 patients suffered from antibiotic-associated diarrhea, 92 of them were diagnosed with CDAD. Risk factors of CDAD were extracted by using Logistic regression analysis. Clostridium difficile grown on Cycloserine-cefoxitin-fruetose agar were molecularly typed with PCR ribotyping method. Results Nasogastric tube feeding, multiple chronic diseases, higher APACHE Ⅱ score, high level of serum C reaction protein, and use of third-generation cephalosporin, quinolone or combination of antibiotics increased the odds of CDAD, whereas use of glycopeptide or nitro-inidazole antibiotics decreased the odds of CDAD （P〈0. 05 ,P〈0. 01）. Twenty strains of Clostridium difficile were classified into 5 ribotypes, and 8 of them were GZ Ⅲ. Conclusion Morbidity of CDAD is high in inpatients, measures which contribute to reducing risk factors should he taken to prevent CDAD.

关 键 词：艰难梭菌相关性腹泻 危险因素 抗生素相关性腹泻 抗生素 PCR核糖体基因分型 护理干预 

分 类 号：R471[医药卫生—护理学] R378.8[医药卫生—临床医学]