State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
Department of Laboratory Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
Hepatobiliary Pancreat Dis Int. 2019 Jun;18(3):237-241. doi: 10.1016/j.hbpd.2019.04.003. Epub 2019 Apr 16.
Cirrhotic patients are susceptible to Clostridium difficile infection (CDI), however, the high risk factors are not clear. The present study aimed to identify the risk factors in cirrhotic patients with CDI.
A total of 526 cirrhotic patients admitted to our hospital between May 2015 and October 2015 were included in this study. Stool samples were collected upon admission for the detection of CDI and toxin. CDI was monitored during the hospital stay. In total, 34 cases showed CDI. Then we analyzed the effects of age, sex, C. difficile colonization (CDC), multiple hospitalization, extended hospital stay, elevation of total bilirubin (TBIL), creatinine (Cr), Child-Pugh grade C, hepatic encephalopathy, hepatorenal syndrome, upper gastrointestinal hemorrhage, and exposure of antibiotics and proton pump inhibitor (PPI) on the CDI in cirrhotic patients.
Patients in the CDI group had more frequent CDC, multiple hospitalization, and extended hospital stay compared to those in the non-C. difficile infection (NCDI) group. Patients in the CDI group had higher TBIL and Cr, and higher frequency of Child-Pugh grade C, hepatic encephalopathy, upper gastrointestinal hemorrhage compared with those in the NCDI group. Multiple logistic regression analysis indicated that age >60 years (OR=1.689; 95% CI: 1.135-3.128), multiple hospitalization (OR=3.346; 95% CI: 1.392-8.043), length of hospital stay >20 days (OR=1.564; 95% CI: 1.113-2.563), hypoproteinemia (OR=4.962; 95% CI: 2.053-11.996), CDC (OR=18.410; 95% CI: 6.898-49.136), hepatic encephalopathy (OR=1.357; 95% CI: 1.154-2.368), and exposure of antibiotics (OR=1.865; 95% CI: 1.213-2.863) and PPI (OR=3.125; 95% CI: 1.818-7.548) were risk factors of CDI.
Age >60 years, multiple hospitalization, length of hospital stay >20 days, hypoproteinemia, CDC, hepatic encephalopathy, and exposure of antibiotics and PPI were risk factors for CDI in cirrhotic patients. These may contribute to the early diagnosis and monitoring of CDI in clinical practice.
肝硬化患者易感染艰难梭菌（CDI），但高危因素尚不清楚。本研究旨在确定 CDI 肝硬化患者的危险因素。
2015 年 5 月至 2015 年 10 月期间我院收治的 526 例肝硬化患者纳入本研究。入院时采集粪便样本进行 CDI 和毒素检测。住院期间监测 CDI。共 34 例出现 CDI。然后我们分析了年龄、性别、艰难梭菌定植（CDC）、多次住院、住院时间延长、总胆红素（TBIL）、肌酐（Cr）升高、Child-Pugh 分级 C、肝性脑病、肝肾综合征、上消化道出血以及暴露于抗生素和质子泵抑制剂（PPI）对肝硬化患者 CDI 的影响。
CDI 组患者 CDC 发生率、多次住院和住院时间延长的频率高于非艰难梭菌感染（NCDI）组。与 NCDI 组相比，CDI 组患者的 TBIL 和 Cr 更高，Child-Pugh 分级 C、肝性脑病、上消化道出血的发生率更高。多因素 logistic 回归分析表明，年龄>60 岁（OR=1.689；95%CI：1.135-3.128）、多次住院（OR=3.346；95%CI：1.392-8.043）、住院时间>20 天（OR=1.564；95%CI：1.113-2.563）、低蛋白血症（OR=4.962；95%CI：2.053-11.996）、CDC（OR=18.410；95%CI：6.898-49.136）、肝性脑病（OR=1.357；95%CI：1.154-2.368）和暴露于抗生素（OR=1.865；95%CI：1.213-2.863）和 PPI（OR=3.125；95%CI：1.818-7.548）是 CDI 的危险因素。
年龄>60 岁、多次住院、住院时间>20 天、低蛋白血症、CDC、肝性脑病以及暴露于抗生素和 PPI 是肝硬化患者 CDI 的危险因素。这些可能有助于临床实践中 CDI 的早期诊断和监测。
