许文芳 叶关胜 金法祥 童丹 俞建洪 王钧 吕秋琼 周亚娣 陈雪芳

[摘要] 目的 探讨老年住院患者难辨梭菌感染危险因素，以期降低感染率。 方法 选取2010年3月～2013年3月绍兴地区老年住院难辨梭菌感染患者500例，作为研究组，选取同时期500例非难辨梭菌感染住院患者作为对照组，比较两组患者的临床资料，采用非条件Logistic回归法进行多因素分析。 结果 老年住院患者难辨梭菌感染单危险因素有胃肠手术、应用碳青酶烯类抗菌药物、应用质子泵抑制剂、应用非甾体抗炎药、抗菌药物使用时间、抗菌药物联合使用、抗菌药物种类（>2种）、应用免疫抑制剂、住院时间（P<0.05）；应用免疫抑制剂、抗菌药物时间>2周、应用碳青酶烯类抗菌药物、实施胃肠手术是老年难辨梭菌感染多危险因素（P=0.003、0.001、0.013、0.014）。 结论 老年住院患者难辨梭菌感染因素有应用免疫抑制剂、长期使用抗菌药物，应用碳青酶烯类抗菌药物，实时胃肠手术，在临床上要结合患者病情特点用药情况，并要加强应对措施。

[关键词] 难辨梭菌感染；危险因素；应当措施；绍兴地区

[中图分类号] R181.3 [文献标识码] A [文章编号] 1673-9701（2015）34-0004-03

Risk factors analysis of clostridium difficile infection in elderly hospitalized patients in Shaoxing area

XU Wenfang YE Guansheng JIN Faxiang TONG Dan YU Jianhong WANG Jun LV Qiuqiong ZHOU Yadi CHEN Xuefang

Department of Clinical Laboratory， Shaoxing Municipal Hospital in Zhejiang Province， Shaoxing 312000， China

[Abstract] Objective To investigate risk factors of clostridium difficile infection in elderly hospitalized patients in Shaoxing city for reducing infection rates. Methods A total of 500 cases of elderly hospitalized patients infected with clostridium difficile from March 2010 to March 2013 in Shaoxing area， were chosen as the study group， and 500 cases of non-clostridium difficile infection hospitalized patients at the same period were chosen as the control group. Clinical data of the two groups were compared， and non-conditional Logistic regression was used in multiplicity. Results Single-risk factors of clostridium difficile infection in elderly hospitalized patients were gastrointestinal surgery， application of carbapenem， application of proton pump inhibitors， application of non-steroidal anti-inflammatory drugs， application time of antibacterials， the combined use of antimicrobial agents， types of antibacterial drugs （> 2 types）， application of immunosuppressive agents and hospital stay （P<0.05）. Application of immunosuppressive agents， application time of antibacterials > 2 weeks， application of antibiotics including carbapenem and implementation of gastrointestinal surgery were multi-risk factors in elderly difficile clostridium infections （P=0.003， 0.001， 0.013， 0.014 respectively）. Conclusion Risk factors of clostridium difficile infection in elderly hospitalized patients are application of immunosuppressive agents， application of antibacterials for long time and application of antibiotics including carbapenem. Before gastrointestinal surgery， the clinical characteristics of patients and drug-use condition should be considered， and countermeasures should be strengthened.

[Key words] Clostridium difficile infection； Risk factors； Countermeasures； Shaoxing area

研究表明，难辨梭菌是造成抗菌药物相关性腹泻和假膜性结肠炎主要致病菌，难辨梭菌感染在全球范围内近些年逐渐升高[1]，欧美地区已将其列入常规监测病原菌，但由该细菌本身生物学特性和检测手段滞后，在我国难辨梭菌感染目前仍处于起步阶段，缺乏大样本系统性分析，而随着老龄化社会加重和抗生素大量使用，同时老年人本身临床疾病的多样性和复杂性，造成感染较特殊[2]。本次……