摘要
目的分析上海交通大学医学院附属瑞金医院急诊重症监护病房(EICU)危重症患者艰难梭菌(CD)感染(CDI)和(或)定植(CDC)的临床特征、危险因素及其预后,为临床治疗提供理论依据。方法连续收集2016年6月至2020年6月收治于上海交通大学医学院附属瑞金医院EICU患者的病例资料,采用回顾性病例对照研究,以CDI/CDC患者作为研究对象(CD阳性组),并以同期入院的性别相同、年龄相差小于5岁的CD阴性患者作为对照(CD阴性组)。收集患者的流行病学、危险因素、预后资料及粪便样本,采用单因素分析、二元Logistic回归分析不同临床特征患者的CD阳性感染率、危险因素及CD阳性对院内死亡的影响。结果487例EICU患者中,纳入CD阳性组76例,CD阳性率为15.6%,其中CDI 11例,CDC 65例。76例CD阳性患者均使用了质子泵抑制剂(PPI),其中至少使用1种抗菌药物75例。纳入CD阴性伴或不伴腹泻者76例(CD阴性组),其中使用PPI 75例,至少使用1种抗菌药物74例。单因素分析显示,急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、住院时间及碳青霉烯类抗菌药物治疗是导致CDI/CDC的危险因素,CD阳性组与CD阴性组上述指标差异均有统计学意义〔APACHEⅡ评分(分):18.0(12.2,25.8)比10.0(7.0,14.0),住院时间(d):46.0(30.5,72.5)比18.5(9.2,37.0),碳青霉烯类抗菌药物治疗比例:81.6%(62/76)比64.5%(49/76),均P<0.05〕。进一步行二元Logistic回归分析显示,APACHEⅡ评分〔优势比(OR)=0.802,95%可信区间(95%CI)为0.730~0.882,P<0.01〕及住院时间(OR=0.960,95%CI为0.942~0.978,P<0.01)是CDI/CDC的独立危险因素。CD阳性组患者病死率与CD阴性组相比差异无统计学意义〔27.6%(21/76)比38.2%(29/76),P=0.167〕。结论EICU危重症患者常规使用PPI及抗菌药物,使用抗菌药物治疗并不影响CDI/CDC的发生;APACHEⅡ评分及住院时间是造成CDI/CDC的独立危险因素,粪便CD阳性不会增加危重症患者的病死率。
Objective To investigate the clinical features,risk factors and prognosis of Clostridium difficile infection/colonization(CDI/CDC)in emergency intensive care unit(EICU)of Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine,then provides theoretical basis for clinical treatment.Methods A retrospective case-control study was conducted.The data of EICU patients admitted to Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine from June 2016 to June 2020 were collected.Taking the CDI/CDC patients as research objects[Clostridium difficile(CD)positive group]and the CD negative patients with the same gender and age difference less than 5 years who were admitted to the hospital during the same period as the control(CD negative group).Demographic information,risk factors,prognosis and stool samples were collected.Single factor analysis and binary Logistic regression were used to analyze the CD positive infection rate,risk factors,and hospital death of patients with different clinical characteristics.Results About 487 patients in EICU were included,76 cases were taken into CD positive group,CD positive rate was 15.6%,including CDI 11 cases,CDC 65 cases.Among the CD positive group,all of the cases used proton pump inhibitor(PPI),and 75 cases used at least one antibiotic.Seventy-six CD negative patients with or without diarrhea(CD negative group)were included in this study.Among them,75 patients used PPI and 74 patients used at least one antibiotic.Univariate analysis showed that acute physiology and chronic health evaluationⅡ(APACHEⅡ),duration of hospitalization,and carbapenem use were the risk factors for CDI/CDC.There were significant differences in the above indicators between CD positive group and CD negative group[APACHEⅡ:18.0(12.2,25.8)vs.10.0(7.0,14.0),duration of hospitalization(days):46.0(30.5,72.5)vs.18.5(9.2,37.0),proportion of carbapenems:81.6%(62/76)vs.64.5%(49/76),all P<0.05].Binary Logistic analysis regression analysis showed that APACHEⅡscore[odds ratio(OR)=0.802,95%confidence interval(95%CI)was 0.730-0.882,P<0.01]and duration of hospitalization(OR=0.960,95%CI was 0.942-0.978,P<0.01)were independent risk factors for CDI/CDC.There was no difference in overall mortality between the CD positive group and CD negative group[27.6%(21/76)vs.38.2%(29/76),P=0.167].Conclusions Critically ill patients in EICU routinely use PPI and antibiotics,and the use of antibiotics does not affect the CD positive rate.The independent risk factors of CDI/CDC are the APACHEⅡscore and the duration of hospitalization,but fecal CD positive has no obvious influence on death.
作者
虞美玲
赵冰
陈影
盛慧球
陈尔真
杨之涛
毛恩强
Yu Meiling;Zhao Bing;Chen Ying;Sheng Huiqiu;Chen Erzhen;Yang Zhitao;Mao Enqiang(Department of Emergency Intensive Care Unit,Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200025,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2021年第11期1358-1361,共4页
Chinese Critical Care Medicine
基金
上海市医学领军人才项目(006)。
关键词
艰难梭菌
感染
定植
危险因素
急诊重症监护病房
Clostridium difficile
Infection
Colonization
Risk factor
Emergency intensive care unit
