创伤性骨折患者艰难梭状芽孢杆菌感染的流行病学调查及对临床预后的影响  

Epidemiological investigation and clinical prognosis of Clostridium difficile infections in patients with traumatic fracture

作　　者：陈笑宇 朱陈宏 颜海彬 蔡建华 李凤平 

机构地区：[1]温岭市第一人民医院骨科,浙江温岭317500 [2]温岭市第一人民医院外科,浙江温岭317500 [3]温岭市第一人民医院急诊科,浙江温岭317500

出　　处：《中华医院感染学杂志》2017年第18期4191-4194,共4页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生一般研究计划基金资助项目(2015KYB448)

摘　　要：目的探讨创伤性骨折患者艰难梭状芽孢杆菌感染的流行病学调查及对患者临床预后的影响,为创伤性骨折患者艰难梭状芽孢杆菌感染的临床预防提供可靠依据。方法选择2012年5月-2016年5月医院骨科收治的创伤性开放性骨折合并腹泻患者185例,将检出艰难梭状芽孢杆菌感染28例患者作为阳性组,再选择60例无艰难梭状芽孢杆菌感染患者作为阴性组,分析艰难梭状芽胞杆菌感染危险因素、艰难梭状芽胞杆菌感染对患者血清炎症因子水平的影响以及对患者日常生活能力(ADL)评分及住院时间的影响。结果送检185份标本中,共检出艰难梭状芽孢杆菌毒素检测阳性28份,阳性率15.14%;单因素及多因素logistic分析显示,合并胃肠道疾病及腹泻天数为创伤性开放性骨折患者发生艰难梭状芽胞杆菌感染的独立危险因素;艰难梭状芽孢杆菌感染阳性组患者其血清降钙素原(PCT)、白细胞介素-6(IL-6)、超敏C-反应蛋白(hs-CRP)水平显著高于阴性组,差异有统计学意义(P<0.05);艰难梭状芽孢杆菌检出阳性组患者其ADL评分显著低于阴性组,差异有统计学意义(P<0.05),阳性组住院时间显著长于阴性组,差异有统计学意义(P<0.05)。结论合并胃肠疾病及长时间腹泻是创伤性开放性骨折住院患者艰难梭状芽孢杆菌感染的独立危险因素,艰难梭状芽孢杆菌感染将引起患者机体炎症水平的升高,影响患者预后。OBJECTIVE To investigate the epidemiology of Clostridium difficile infections in patients with traumatic fractureand its effect on the prognosis of the patients,so as to provide a reliable basis for clinical prevention of C.difficileinfections in patients with traumatic fracture.METHODS A total of 185 cases of open traumatic fracture patients with diarrhea from May 2012 to May 2016 were selected.The 28 patients with the detection of C.difficileinfections were set as positive group,and 60 cases without C.difficileinfections were used as negative group.The risk factors of C.difficileinfections,and the effects of C.difficileinfections on the levels of serum inflammatory factors,the ability of daily life（ADL）score and the duration of hospitalization of patients were analyzed.RESULTS From 185 specimens,28cases of C.difficile toxin were detected,and the positive rate was 15.14% .Univariate and multivariate logistic analysis showed that patients with gastrointestinal diseases and diarrhea days were independent risk factors for C.difficileinfection in patients with open traumatic fracture.The serum procalcitonin（PCT）,interleukin-6（IL-6）and high sensitive C-reactive protein（hs-CRP）levels in C.difficileinfection group were significantly higher than those in negative group（P〈0.05）.The ADL scores in C.difficileinfection group were significantly lower than that in negative group（P〈0.05）,and the hospitalization time in C.difficile infection group was significantly longer than that in negative group（P〈0.05）.CONCLUSION Combination with gastrointestinal diseases and long time diarrhea were independent risk factors for C.difficileinfection in patients with open traumatic fracture.C.difficileinfections will increase the inflammatory levels of patients,thus affecting the prognosis of patients.

关 键 词：创伤性骨折 艰难梭状芽孢杆菌 流行病学 临床预后 

分 类 号：R378[医药卫生—病原生物学]