急性内科病房中2型糖尿病患者的医院获得性艰难梭菌感染

Hospital-acquired Clostridium difficile infection among patients with type 2 diabetes mellitus in acute medical wards.

作者信息

Hassan S A, Rahman R A, Huda N, Wan Bebakar W M, Lee Y Y

机构信息

Department of Medical Microbiology and Parasitology, Universiti Sains Malaysia, Kelantan, Malaysia.

出版信息

J R Coll Physicians Edinb. 2013;43(2):103-7. doi: 10.4997/JRCPE.2013.203.

DOI:10.4997/JRCPE.2013.203

PMID:23734349

Abstract

BACKGROUND

Clostridum difficile (C. difficile) infection is increasingly seen among hospitalised patients with type 2 diabetes mellitus but its rate and associated risk factors are not known. We aimed to determine the rate and characteristics of hospital-acquired C. difficile infection in subjects with type 2 diabetes mellitus admitted into acute medical wards.

METHODS

Our prospective cross-sectional study involved 159 patients with established type 2 diabetes mellitus admitted into acute medical wards who developed a hospital-acquired C. difficile infection. Stools were tested for C. difficile toxins using a toxin A/B kit and a toxin A kit. Clinical features, laboratory findings, types of antibiotics, and use of a proton pump inhibitor were examined for their association with the infection.

RESULTS

Thirteen subjects were positive for toxin A and one for toxin B. Using univariable analysis, we found that patients with type 2 diabetes mellitus and hospital acquired C. difficile infection were younger (mean 53.8 years, p=0.02), had diarrhoea and abdominal pain (p=0.001) but no fever. Sepsis (p=0.02) and use of a proton pump inhibitor (p=0.01) were more commonly implicated as the cause of the infection. Of the various types of antibiotics prescribed, carbapenem (28.6% vs 4.1%, p=0.01) and metronidazole (42.9% vs 19.3%, p=0.04) were significantly associated with hospital acquired C. difficile infection.

CONCLUSIONS

Patients with type 2 diabetes mellitus admitted into acute medical wards and who developed hospital-acquired C. difficile infection have distinct characteristics.

摘要

背景

艰难梭菌感染在2型糖尿病住院患者中越来越常见，但其发生率及相关危险因素尚不清楚。我们旨在确定入住急性内科病房的2型糖尿病患者医院获得性艰难梭菌感染的发生率及特征。

方法

我们的前瞻性横断面研究纳入了159例确诊为2型糖尿病且入住急性内科病房并发生医院获得性艰难梭菌感染的患者。使用毒素A/B检测试剂盒和毒素A检测试剂盒对粪便进行艰难梭菌毒素检测。研究临床特征、实验室检查结果、抗生素类型及质子泵抑制剂的使用与感染的相关性。

结果

13例患者毒素A检测呈阳性，1例毒素B检测呈阳性。单因素分析发现，2型糖尿病合并医院获得性艰难梭菌感染的患者更年轻（平均53.8岁，p = 0.02），有腹泻和腹痛症状（p = 0.001），但无发热。脓毒症（p = 0.02）和质子泵抑制剂的使用（p = 0.01）更常被认为是感染的原因。在使用的各类抗生素中，碳青霉烯类（28.6% 对4.1%，p = 0.01）和甲硝唑（42.9% 对19.3%，p = 0.04）与医院获得性艰难梭菌感染显著相关。