神经外科患者入院时产毒性艰难梭菌定植率及其危险因素研究  

Colonization of toxigenic Clostridium difficile in neurosurgery department patients at admission to hospital and risk factors

作　　者：祁琪 高洁 石荃 茅一萍 郑伟 张冰 陈云波 QI Qi;GAO Jie;SHI Quan;MAO Yi-ping;ZHENG Wei;ZHANG Bing;CHEN Yun-bo(School of Nursing of Xuzhou Medical University,Xuzhou Jiangsu 221000,China;不详)

机构地区：[1]徐州医科大学护理学院,江苏徐州221000 [2]徐州医科大学附属医院感染管理科,江苏徐州221000 [3]浙江大学附属第一医院传染病诊治国家重点实验室,浙江杭州310000

出　　处：《中华医院感染学杂志》2020年第6期872-877,共6页Chinese Journal of Nosocomiology

基　　金：江苏省研究生科研与实践创新计划基金资助项目(KYCX18_2183)。

摘　　要：目的研究神经外科患者入院时艰难梭菌携带情况与艰难梭菌定植的危险因素。方法采集2018年11月-2019年4月徐州医科大学附属医院神经外科病房新入院患者的粪便标本进行产毒艰难梭菌培养与A/B毒素检测,结合患者一般资料及病历资料等信息,分析产毒艰难梭菌定植的危险因素。结果 161例粪便标本共培养分离出艰难梭菌菌株26(16.15%)株,其中非产毒艰难梭菌菌株4株,产毒性艰难梭菌22株,产毒性艰难梭菌定植率13.66%。Logistic回归分析显示,3个月内抗菌药物使用史、3个月内住院史和糖尿病史为患者艰难梭菌定植的独立危险因素,OR值分别为3.55(95%CI:1.1~11.47)、3.80(95%CI:1.13~12.76)和4.60(95%CI:1.06~19.95)。结论神经外科患者入院时产毒艰难梭菌定植率介于其他医院的比例之间。既往抗菌药物使用、住院史及糖尿病史可以增加艰难梭菌定植风险,应加强对相关患者的监测和筛查,是否需要制定相应措施进行防控,仍需进一步的研究证实。OBJECTIVE To investigate the prevalence of Clostridium difficile in neurosurgery department patients at admission to hospital and analyze the risk factors for colonization of C.difficile. METHODS The stool samples were collected from the patients who were just admitted to the wards of neurosurgery department of the Hospital Affiliated to Xuzhou Medical University from Nov 2018 to Apr 2019 so as to carry out the culture of toxigenic C.difficile and A/B toxin test, and the risk factors for colonization of toxigenic C.difficile were analyzed in combination with the baseline data and medical records of the patients. RESULTS A total of 26(16.15%) strains of C.difficile were isolated from the 161 stool samples, 4 of which were non-toxigenic C.difficile, and 22 were toxigenic C.difficile, and the colonization rate of toxigenic C.difficile was 13.66%. Logistic regression analysis showed that history of use of antibiotics within 3 months, history of hospital stay within 3 months and history of diabetes mellitus were the independent risk factors for the colonization of C.difficile, and the OR values were 3.55(95%CI:1.1~11.47), 3.80(95%CI:1.13~12.76) and 4.60(95%CI:1.06~19.95), respectively. CONCLUSION The colonization rate of the toxigenic C.difficile in the neurosurgery department patients ranges between the ratios of other hospitals at the admission to hospital. Previous use of antibiotics, history of hospital stay and history of diabetes mellitus may increase the risk of colonization of C.difficile. It is necessary to strengthen the monitoring and screening of relevant patients and conduct further study to verify whether targeted prevention measures need to be formulated.

关 键 词：艰难梭菌 产毒艰难梭菌定植 神经外科 危险因素 

分 类 号：R378[医药卫生—病原生物学]