Vaishnavi Chetana, Gupta Pramod K, Sharma Megha, Kochhar Rakesh
1Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India.
2Department of Biostatistics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India.
Gut Pathog. 2019 Apr 23;11:17. doi: 10.1186/s13099-019-0300-2. eCollection 2019.
Surveillance of infection (CDI) in patients with underlying diseases is important because use of prophylactic antibiotics makes them prone to CDI. Epidemiology of CDI in this high-risk population is poorly understood. A study was conducted to evaluate the impact of CDI in patients with specific underlying co-morbidities.
A total of 2036 patients, whose fecal samples were processed for toxin A and B assay by ELISA formed the basis of study. Patients with underlying diseases were classified based on the organ/kind of disease as pancreatic (= 340), renal (= 408), hepatic (= 245), malignant (= 517) and miscellaneous disease (= 526). Laboratory records of clinical and demographic details were reviewed. The association of CDI with age, gender, antibiotic receipt, clinical symptoms and underlying co-morbidities was analyzed. Variation in CDI cases based on age groups was also investigated.
toxin positivity was 21.6% in general, whereas it was 30.6% in the pancreatic, 17.9% in the renal, 19.6%, in the hepatic, 21.3% in the malignancy and 20.0% in the miscellaneous disease groups. Toxin positivity was the lowest (14.8%) for female gender under renal disease and the highest (31.8%) for patients aged 40 to < 60 years, under pancreatic disease. Bloody diarrhea was a significant predictor for toxin positivity. toxin status irrespective to the underlying diseases was neither dependent on gender, age-groups or the number of antibiotics used. Association between patients' gender, age and antibiotics receipt with underlying disease conditions, respective to toxin status showed significance in relation to male gender (p < 0.05), age 40 to < 60 years (p = 0.03) and those receiving single (p = 0.09) or multiple antibiotics (p = 0.07).
Pancreatic disease patients are at a higher risk for developing CDI, and particularly male gender, age 40 to < 60 years and those receiving antibiotics are at significant risk.
对患有基础疾病的患者进行艰难梭菌感染（CDI）监测很重要，因为预防性使用抗生素会使他们易患CDI。对这一高危人群中CDI的流行病学了解甚少。开展了一项研究以评估CDI对患有特定基础合并症患者的影响。
共有2036例患者，其粪便样本通过酶联免疫吸附测定法（ELISA）进行毒素A和B检测，构成了研究基础。患有基础疾病的患者根据器官/疾病种类分为胰腺疾病组（=340例）、肾脏疾病组（=408例）、肝脏疾病组（=245例）恶性疾病组（=517例）和其他疾病组（=526例）。回顾了临床和人口统计学详细信息的实验室记录。分析了CDI与年龄、性别、抗生素使用情况、临床症状和基础合并症之间的关联。还调查了不同年龄组CDI病例的差异。
总体毒素阳性率为21.6%，而胰腺疾病组为30.6%，肾脏疾病组为17.9%，肝脏疾病组为19.6%，恶性疾病组为21.3%，其他疾病组为20.0%。肾脏疾病女性患者的毒素阳性率最低（14.8%），胰腺疾病40至<60岁患者的毒素阳性率最高（31.8%）。血性腹泻是毒素阳性的重要预测因素。无论基础疾病如何，毒素状态均不依赖于性别、年龄组或使用的抗生素数量。患者性别、年龄和抗生素使用情况与基础疾病状况之间的关联，相对于毒素状态而言，在男性（p<0.05）、40至<60岁（p=0.03）以及接受单一（p=0.09）或多种抗生素（p=0.07）的患者中具有显著意义。
胰腺疾病患者发生CDI的风险较高，尤其是男性、40至<60岁以及使用抗生素的患者风险显著。
