Huang Haihui, Wu Shi, Chen Renjie, Xu Shaohua, Fang Hong, Weintraub Andrej, Nord Carl Erik
Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.
Department of Health Statistics and Social Medicine, School of Public Health, Fudan University, Shanghai, China.
Anaerobe. 2014 Dec;30:65-9. doi: 10.1016/j.anaerobe.2014.08.015. Epub 2014 Sep 8.
Clostridium difficile infection (CDI) is an increasing concern in China. However, the risk factors of CDI are rarely reported in the Chinese population. A prospective observational study was therefore conducted among patients with hospital-acquired C. difficile diarrhoea and the risk factors of CDI in a retrospective case-control study. The CDI patients were compared with the non-CDI diarrhoeal patients and those without diarrhoea, respectively. The recurrent CDI patients were compared with the corresponding non-recurrent CDI patients and those without diarrhoea, respectively. Overall, of the 240 patients with hospital-acquired diarrhoea 90 (37.5%) were diagnosed as CDI, and 12 (13.3%) of the 90 CDI patients experienced recurrence. Multivariate analysis indicated that renal disease, malignancy, hypoalbuminemia, prior antibiotic treatment, chemotherapy, nasogastric tube use, length of stay>14 days and intra-abdominal surgery, defined daily dose of antimicrobial agents≥19, prior use of more than three antimicrobial agents, and use of carbapenems were independent risk factors for the first episode of CDI. Use of laxatives, the first- and second-generation narrow-spectrum cephalosporins or metronidazole was identified as protective factors. It is necessary to make testing of C. difficile available as a routine practice and control these risk factors in Chinese hospitals to avoid CDI outbreaks.
艰难梭菌感染（CDI）在中国日益受到关注。然而，中国人群中CDI的危险因素鲜有报道。因此，我们对医院获得性艰难梭菌腹泻患者进行了一项前瞻性观察研究，并在一项回顾性病例对照研究中分析了CDI的危险因素。分别将CDI患者与非CDI腹泻患者以及无腹泻患者进行比较。将复发性CDI患者分别与相应的非复发性CDI患者和无腹泻患者进行比较。总体而言，在240例医院获得性腹泻患者中，90例（37.5%）被诊断为CDI，90例CDI患者中有12例（13.3%）出现复发。多因素分析表明，肾脏疾病、恶性肿瘤、低白蛋白血症、既往抗生素治疗、化疗、使用鼻胃管、住院时间>14天、腹部手术、限定日剂量抗菌药物≥19、既往使用三种以上抗菌药物以及使用碳青霉烯类药物是CDI首次发作的独立危险因素。使用泻药、第一代和第二代窄谱头孢菌素或甲硝唑被确定为保护因素。在中国医院，有必要将艰难梭菌检测作为常规操作，并控制这些危险因素以避免CDI暴发。
