重症监护病房AAD调查与艰难梭菌病原检测

发布时间：2018-03-22 04:10

本文选题：艰难梭菌　切入点：艰难梭菌相关性腹泻　出处：《中南大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的：(1)通过对某院ICU住院患者中发生抗生素相关性腹泻的患者粪便进行厌氧培养,进行细菌鉴定,了解艰难梭菌的感染情况。 (2)统计分析艰难梭菌相关性腹泻与非艰难梭菌所致抗生素相关腹泻的各种因素,明确两者在危险因素及临床特征上的差异。方法：对2012年10月-2013年3月某院ICU(包括中心ICU、神经外科ICU、神经内科ICU、呼吸ICU、急诊ICU)患者进行前瞻性监测。严格按照病例纳入及排除标准,对发生抗生素相关性腹泻的患者进行调查和大便标本进行艰难梭菌的厌氧培养,并做菌株鉴定；对艰难梭菌腹泻患者与非艰难梭菌所致抗生素相关腹泻患者进行分组,对各种因素进行Chi-square检验和t检验,分析临床特征及危险因素等方面的差异。结果：调查的6个月期间,共有1322例ICU住院患者,纳入抗生素相关性腹泻患者82例,抗生素相关腹泻发病率为6.2%(82/1322)；82例抗生素相关性腹泻患者大便标本中,培养出艰难梭菌8株,分离率为9.8%(8/82),该院ICU病房的ADCD发病率为61/100,000患者(8/1322)。82例发生抗生素相关性腹泻的患者,男性56例(68.29%),女性26例(31.70%),平均年龄54.31±19.67岁,基础疾病主要有脑出血19例(23.17%),恶性肿瘤16例(19.51%),重型肺炎13例(15.85%)。所有患者均使用过头孢类、广谱青霉素类、喹诺酮类、碳青霉烯类等广谱抗菌药物中的一种或多种,抗菌药物平均使用时间为7.26±7.26天。对比两组患者危险因素：年龄、性别、抗生素使用种类、抗生素联用情况、抗生素使用时间,是否使用质子泵抑制剂等因素,均无统计学差异；对比两组患者临床特征：是否发热、腹泻次数、有无腹痛、呕吐、血常规wbc是否升高等因素,均无统计学差异。结论：该院ICU病房艰难梭菌相关性腹泻发病率较低。艰难梭菌相关性腹泻与非艰难梭菌所致抗生素相关腹泻患者在危险因素及临床表现上,均无统计学差异,因此很难从危险因素相关性及临床表现上将两者区分开来,病原检测是区别艰难梭菌相关性腹泻与其它抗生素相关性腹泻的有效方法
[Abstract]:Objective to investigate the infection of Clostridium diffusa by anaerobic culture of feces of patients with antibiotic associated diarrhea in a hospital with ICU. (2) the statistical analysis of various factors of clostridium-related diarrhea and antibiotic-associated diarrhea caused by non-Clostridium davidii, and the difference of risk factors and clinical characteristics between them. Methods: patients with ICU (including central ICU, neurosurgery ICU, neurology ICU, respiratory ICU, emergency ICU) in a hospital from October 2012 to March 2013 were prospectively monitored. The patients with antibiotic associated diarrhea were investigated and fecal specimens were cultured and identified by anaerobic culture, and the patients with Clostridium diffuciae and those with antibiotic associated diarrhea caused by non-Clostridium davidii were divided into two groups. The differences of clinical characteristics and risk factors were analyzed by Chi-square test and t test. Results: during the period of 6 months, there were 1322 hospitalized patients with ICU, including 82 patients with antibiotic associated diarrhea. The incidence of antibiotic associated diarrhea was 6.2 / 82 / 1322 / 82 stool samples of patients with antibiotic associated diarrhea, 8 strains of Clostridium difficulty were cultured. The isolation rate was 9. 8 / 82. The incidence of ADCD in the ICU ward of this hospital was 61 / 100 000 patients, 81 / 100 000 patients and 82 patients with antibiotic associated diarrhea. There were 56 males with 68.29m, 26 females with 31. 70g, with an average age of 54.31 卤19. 67 years. The main underlying diseases were cerebral hemorrhage in 19 cases, malignant tumor in 16 cases and severe pneumonia in 13 cases. All the patients had used one or more of the broad-spectrum antimicrobial agents, such as cephalosporins, broad-spectrum penicillin, quinolones, carbapenems, etc. The mean use time of antibiotics was 7.26 卤7.26 days. There was no significant difference in the risk factors between the two groups: age, sex, types of antibiotics, combined use of antibiotics, duration of antibiotic use and whether proton pump inhibitors were used. There was no statistical difference between the two groups in the clinical characteristics: fever, diarrhea, abdominal pain, vomiting, blood routine wbc, etc. Conclusion: the incidence of Clostridium difficulty associated diarrhea is low in ICU ward of our hospital. There is no significant difference in risk factors and clinical manifestations between the patients with Clostridium dysentery associated diarrhea and those with antibiotic associated diarrhea caused by non-Clostridium diffucius. Therefore, it is difficult to distinguish the risk factors from the clinical manifestations. Pathogen detection is an effective method to distinguish Clostridium difficulty associated diarrhea from other antibiotic related diarrhea.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R515.9

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