难辨梭状芽胞杆菌感染与定植的危险因素分析  

Risk factors of Clostridium difficile infections and colonization

作　　者：刘聚源[1] 蔡虻[1] 胡云建 李燕明[1] 刘安雷[3] 邵文博[1] 李娜[1] 

机构地区：[1]卫生部北京医院医院感染管理处 [2]检验科,北京100730 [3]中国医学科学院北京协和医院急诊科,北京100730

出　　处：《中华医院感染学杂志》2013年第20期5070-5072,共3页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金(30971097)

摘　　要：目的调查难辨梭状芽胞杆菌感染与定植资料,探讨医院难辨梭状芽胞杆菌感染与定植的影响因素,为预防难辨梭状芽胞杆菌感染与定植病例发生、防止医院传播提供理论依据。方法根据2011-2012年腹泻患者难辨梭状芽胞杆菌培养结果选择病例组(56例)和选择难辨梭状芽胞杆菌培养阴性腹泻患者为对照组(120例);采用成组设计的病例对照研究方法收集病例和对照的信息;应用IBM SPSS 21.0进行基本资料的描述、单因素和多因素的统计分析。结果纳入单因素分析的变量共17个,经过χ2检验(P<0.05),确定11个变量进入非条件logistic回归模型,其中病例组应用质子泵抑制剂(PPI)、抗菌药物使用≥14d、应用碳青霉烯类抗菌药物、实施胃肠手术,分别占75.0%、66.1%、39.3%、26.8%,对照组分别占32.5%、45.0%、15.0%、9.2%;经多因素回归分析,应用PPI(OR=3.218)、抗菌药物使用≥14d(OR=5.124)、应用碳青霉烯类抗菌药物(OR=6.875)、实施胃肠手术(OR=2.107)是难辨梭状芽胞杆菌感染/定植独立的危险因素。结论应用PPI、长期使用抗菌药物、应用碳青霉烯类抗菌药物、实时胃肠手术是难辨梭状芽胞杆菌感染与定植可能的危险因素,应根据患者病情特点、用药情况,积极采取医院感染预防控制措施,防止难辨梭状芽胞杆菌的产生和传播。OBJECTIVE To review the data of infections and colonization of Clpstridium difficile and explore the risk factors for the infection and colonization so as to provide theoretical bases for the prevention of infection and colonization of C. difficile and prevent the transmission. METHODS The diarrhea patients recruited from 2011 to 2012 were divided into the case group （56 cases ） and the control group （120 cases） according to the result of culture of C. difficile; by means of the case-control study, the information of the patients in both the case group and the control group was collected, then the description of baseline data, univariate analysis, and the multivariate analysis were performed with the use of IBM SPSS 21. 0. RESULTS Totally 17 variables have involved in the univariate analysis, and 11 were determined through the chi square test to enter into the unconditional logistic regression model, among which the cases in the case group who used proton pump inhibitors （PPI） accounted for 75.0%, the cases with the use of antibiotics more than 14 days 66. IX, the cases with the use of carbapenems antibiotics 39. 3%, the eases who underwent gastrointestinal surgery 26. 8~, which accounted for 32. 5~, 45.0% ,15.0~, and 9.2%, respectively in the control group. The multivariate regression analysis indicated that the use of PPI（OR=3. 218）,use of antibiotics more than 14 days （OR=5. 124）, use of carbapenems antibiotics （OR=6. 875）, and application of gastrointestinal surgery （OR=2. 107） were the independent risk factors for the infection or colonization of C. difficile. CONCLUSION The use of PPI, long-term use of antibiotics, use of earbapenems antibiotics, and application of gastrointestinal surgery are the risk factors for the infection and colonization of C. difficile; it is necessary to take prevention measures actively according to the condition and medication status so as to prevent the emergence and transmission ef C. difficile.

关 键 词：难辨梭状芽胞杆菌 危险因素 抗菌药物 

分 类 号：R378[医药卫生—病原生物学]