北京一所教学医院艰难梭菌感染分析  

Analysis of Clostridium difficile infection in a teaching hospital in Beijing

作　　者：李曙光[1] 张菲菲[1] 刘井波[1] 陈宏斌[1] 彭秋生[1] 王占伟[1] 李荷楠[1] 王辉[1] 

机构地区：[1]北京大学人民医院检验科,北京100044

出　　处：《中华医院感染学杂志》2017年第19期4352-4355,共4页Chinese Journal of Nosocomiology

基　　金：国家杰出青年基金资助项目(81625014)

摘　　要：目的研究2014-2016年医院艰难梭菌感染情况。方法 2014年6月-2016年5月,临床标本的毒素检测采用酶联免疫法(EIA);随机选择69例非重复住院患者的毒素送检粪便同时进行EIA、GeneXpert PCR和艰难梭菌培养并比较,结合病历回顾研究培养和/或毒素阳性患者的感染及治疗。结果艰难梭菌培养和毒素检测同时送检的非重复患者640例,85例培养或/和毒素阳性,培养阳性率为8.91%,毒素阳性率为7.97%;培养阳性率>10%的科室有胃肠外科、肾内科、风湿免疫内科、消化内科;毒素阳性率>10%的科室有肾内科、骨肿瘤科、风湿免疫内科、胃肠外科、消化内科。标本送检占比56.88%的血液科,其培养、毒素阳性率仅分别为8.24%、5.49%;随机选择的69例非重复患者标本,有9例属于艰难梭菌感染,阳性率为13.04%,培养的灵敏度、特异度分别为66.67%、98.33%;EIA的灵敏度、特异度分别为44.44%、93.33%;PCR的灵敏度、特异度分别为100%、95.00%;相关因素分析,"腹泻时长≥48h"、"每日腹泻≥3次"在艰难梭菌感染组与非感染组中具有显著性差异;培养阳性或毒素阳性均有阳性提示意义,若伴随腹泻症状,应重点考虑艰难梭菌感染并予以万古霉素、甲硝唑和/或肠道菌群调节药物。结论应规范送检标本,选择合适检验方法,重视艰难梭菌感染,避免其成为我国的公共健康威胁。OBJECTIVE To investigate Clostridium difficile infection（CDI）in Peking University People＇s Hospital from 2014 to 2016.METHODS From Jun.2014 to May 2016,clinical fecal specimens were tested by EnzymeLinked Immunosorbent Assay（EIA）.What＇s more,69 random,non-repetitive fecal specimens of inpatients were tested with EIA,GeneXpert PCR and culture-based method.The infection and treatment of cultured and/or toxin positive patients were studied by retrospective study of medical records.RESULTS Totally 640non-repetitive patients did both C.difficile culture and toxin EIA.Among them,85cases（13.28%）were culture positive and/or toxin positive,and the positive rates of culture and toxin were 8.91% and 7.97%,respectively.The departments with culture positive rate above 10% were gastroenterological surgery,nephrology department and rheumatology immunology department and gastroenterology department,and the departments with toxin positive rate above 10% are nephrology department,musculoskeletal tumor department,rheumatology immunology department and gastroenterological surgery and gastroenterology department.However,the culture and toxin positive rates were merely 8.24%and 5.49%for hematology department,whose specimens accounted 56.88% of the hospital.Nine of the randomly selected 69 patients were true C.difficile infection,and the positive rate was 13.04%.The sensitivity and specificity of culture based method were 66.67%and 98.33%,the sensitivity,specificity of toxin EIA were 44.44% and 93.33%,and the sensitivity,specificity of PCR were 100% and 95.00%,respectively. ＂ Diarrhea duration≥ 48h＂ and ＂ diarrhea 3times or more per day＂ were both significantly different between CDI and non-CDI patients.Culture positive or toxin positive were both valuable in CDI indication,especially in patients with diarrhea.If accompanied by diarrhea symptoms,infection with C.difficile should be considered,and vancomycin,metronidazole and/or intestinal flora regulating drugs should be used.CONCLUSION The qualified specimens

关 键 词：艰难梭菌 培养 毒素 GeneXpert PCR 治疗 方法比较 

分 类 号：R378.8[医药卫生—病原生物学]