北京一所教学医院艰难梭菌感染分析

发布时间：2018-05-01 05:18

  本文选题：艰难梭菌 + 培养　； 参考：《中华医院感染学杂志》2017年19期

【摘要】：目的研究2014-2016年医院艰难梭菌感染情况。方法 2014年6月-2016年5月,临床标本的毒素检测采用酶联免疫法(EIA);随机选择69例非重复住院患者的毒素送检粪便同时进行EIA、GeneXpert PCR和艰难梭菌培养并比较,结合病历回顾研究培养和/或毒素阳性患者的感染及治疗。结果艰难梭菌培养和毒素检测同时送检的非重复患者640例,85例培养或/和毒素阳性,培养阳性率为8.91%,毒素阳性率为7.97%;培养阳性率10%的科室有胃肠外科、肾内科、风湿免疫内科、消化内科;毒素阳性率10%的科室有肾内科、骨肿瘤科、风湿免疫内科、胃肠外科、消化内科。标本送检占比56.88%的血液科,其培养、毒素阳性率仅分别为8.24%、5.49%;随机选择的69例非重复患者标本,有9例属于艰难梭菌感染,阳性率为13.04%,培养的灵敏度、特异度分别为66.67%、98.33%;EIA的灵敏度、特异度分别为44.44%、93.33%;PCR的灵敏度、特异度分别为100%、95.00%;相关因素分析,"腹泻时长≥48h"、"每日腹泻≥3次"在艰难梭菌感染组与非感染组中具有显著性差异;培养阳性或毒素阳性均有阳性提示意义,若伴随腹泻症状,应重点考虑艰难梭菌感染并予以万古霉素、甲硝唑和/或肠道菌群调节药物。结论应规范送检标本,选择合适检验方法,重视艰难梭菌感染,避免其成为我国的公共健康威胁。
[Abstract]:Objective to study the infection of Clostridium difficulty in hospital from 2014-2016. Methods Enzyme-linked immunosorbent assay (Elisa) was used to detect the toxin in clinical samples from June 2014 to May 2016, and the feces of 69 non-repeated hospitalized patients were randomly selected to be cultured with EIA-GeneXpert PCR and Clostridium difficult. The infection and treatment of culture and / or toxin positive patients were studied retrospectively. Results the positive rates of culture and toxin were 8.91 and 7.97 respectively in 640 cases of non-repetitive patients, including gastrointestinal surgery, nephrology and rheumatism immunology, in which the positive rate of culture was 8.91, and the positive rate of toxin was 7.97.The positive rate of culture was 10% in the department of gastrointestinal surgery, nephrology and rheumatism immunology. The positive rate of toxin is 10% in the Department of Kidney, Bone Oncology, Rheumatological Immunology, Gastrointestinal surgery, and Gastroenterology. The positive rate of toxin in culture was only 8.24% and 5.49% in hematology, 9 of 69 randomly selected non-repetitive patients were infected by Clostridium diffracta, and the positive rate was 13.04. The sensitivity and specificity of culture were 66.67% and 98.33, respectively. The sensitivity and specificity of PCR were 100 and 95.00, respectively, the relative factor analysis showed that "diarrhea time 鈮，

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