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目的通过检测住院老年患者粪便标本中的艰难梭菌毒素,分析其阳性发生率与其他临床各项指标和因素的相关关系,进而探索住院老年患者艰难梭菌感染发生的可能危险因素,为临床采取积极有效的相关感染防控措施提供一定基础。方法纳入60例65岁以上的老年住院腹泻患者作为研究对象,采用酶联荧光免疫分析(ELFA)法对患者粪便中的艰难梭菌毒素A/B进行定性检测,根据检测结果将患者分为艰难梭菌相关性腹泻阳性组和阴性组,分析年龄、住院时间、抗生素使用情况、鼻饲或质子泵抑制剂治疗与否、慢性病种类、白蛋白水平、中性粒细胞比例等因素,采用SPSS22.0软件对各因素进行统计学处理,分析CDAD阳性患者临床特征及发生的危险因素。结果 60例老年住院患者中有18例艰难梭菌毒素检出,阳性率为30%,其中17例来自内科病区。18例CDAD阳性患者中,6例为鼻饲营养,4例接受质子泵抑制剂治疗。阳性患者均使用过头孢类、碳青霉素类、喹诺酮类等抗生素,15例为混用抗生素。艰难梭菌感染阳性组白蛋白水平均值为31.9±3.4g/L,显著低于阴性组水平,差异具有统计学意义。合并的慢性病发生种类数都对CDAD的发生影响有统计学意义。结论抗生素的使用是艰难梭菌感染的危险因素,合并慢性病及接受鼻饲及质子泵抑制剂治疗的老龄患者,由于免疫力低下,较其他人群更易感染艰难梭菌,对于此类患者,应尤其注意抗生素的使用及院内感染的控制。
Objective To investigate the relationship between the positive rate of Clostridium difficile toxin (CVD) in the stool samples of hospitalized elderly patients and other clinical indicators and factors to explore the possible risk factors of C. difficile infection in hospitalized elderly patients. Positive and effective infection control measures to provide some basis. Methods A total of 60 elderly hospitalized patients with diarrhea aged over 65 years were enrolled in this study. Enzyme-linked immunofluorescence assay (ELFA) was used to qualitatively detect C. difficile toxin A / B in the stool of the patients. According to the test results, patients were divided into difficult Clostridium-associated diarrhea-positive group and negative group, analysis of age, hospital stay, antibiotic use, nasal or proton pump inhibitor treatment or not, chronic diseases, albumin levels, neutrophil ratio and other factors, using SPSS22.0 The software for the treatment of various factors, analysis of CDAD positive patients with clinical features and risk factors. Results Of 60 elderly hospitalized patients, 18 cases of C. difficile toxin were detected, the positive rate was 30%, of which 17 cases were from medical ward. Of 18 CDAD-positive patients, 6 were nasally fed and 4 received proton pump inhibitors. Positive patients were used cephalosporins, carbapenems, quinolones and other antibiotics, 15 were mixed with antibiotics. The mean level of albumin in patients with positive Clostridium difficile infection was 31.9 ± 3.4g / L, which was significantly lower than that in the negative group, the difference was statistically significant. The number of occurrence of chronic diseases combined have a significant impact on the occurrence of CDAD. Conclusions The use of antibiotics is a risk factor for Clostridium difficile infection. Elderly patients with chronic diseases and nasal and proton pump inhibitors are more likely to be infected with Clostridium difficile than their counterparts due to their low immunity Use of antibiotics and control of nosocomial infections.