Clinical characterization and risk factors of Clostridium difficile infection in elderly patients in a Chinese hospital.
Clinical characterization and risk factors of Clostridium difficile infection in elderly patients in a Chinese hospital.
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DOI：
10.3855/jidc.4816
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发表时间：
2015-04
影响因子：
1.9
通讯作者：
Zhang Lihua;Danfeng Dong;Jiang Cen;Xuefeng Wang;Yibing Peng
中科院分区：
文献类型：
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作者：
Zhang Lihua;Danfeng Dong;Jiang Cen;Xuefeng Wang;Yibing Peng
### 引言
艰难梭菌是医院获得性腹泻的常见病因，在老年患者中尤为如此。本研究旨在分析老年住院患者艰难梭菌感染（CDI）的临床特征，并评估相关危险因素。
### 方法
对2010年至2013年间中国一家三级医院60岁以上的老年住院患者进行回顾性病例对照研究。研究纳入了52例CDI患者和150例随机选取的非CDI患者。通过适当的统计学检验比较CDI患者和非CDI患者的临床特征。对一系列因素进行逻辑回归分析，以确定老年住院患者发生CDI的危险因素。
### 结果
与非CDI患者相比，老年CDI患者白细胞计数更高、血清白蛋白水平更低、住院时间更长且死亡率更高。两组患者入住重症监护病房或使用胃酸抑制剂的比例也存在显著差异（p < 0.05）。多变量分析表明，血清肌酐（比值比[OR] 1.004；95%置信区间[CI] 1.001 - 1.008）、手术干预（OR 6.132；95% CI 2.594 - 14.493）、合并症数量（OR 2.573；95% CI 1.353 - 4.892）、胃肠道疾病（OR 4.670；95% CI 2.002 - 10.895）以及抗生素使用（OR 6.718；95% CI 2.846 - 15.859）与CDI独立相关。
### 结论
本研究揭示了老年住院患者发生CDI的几个危险因素。这些发现将增进对该疾病的认识，并为老年人群CDI的防控提供信息。
INTRODUCTION Clostridium difficile is a common cause of nosocomial diarrhea, especially in elderly patients. This study aimed to analyze the clinical features and assess the risk factors associated with Clostridium difficile infection (CDI) in elderly hospitalized patients. METHODOLOGY A retrospective case-control study was conducted among elderly hospitalized patients (> 60 years of age) in a Chinese tertiary hospital between 2010 and 2013. Fifty-two CDI patients and 150 randomly selected non-CDI patients were included in the study. Clinical features of CDI and non-CDI patients were compared by appropriate statistical tests. Logistic regression analyses were performed on a series of factors to determine the risk factors for CDI among the elderly hospitalized patients. RESULTS The elderly CDI patients showed higher leukocyte counts, lower serum albumin levels, longer duration of hospital stay, and higher mortality compared to the non-CDI patients. The proportion of patients admitted to the intensive care unit or exposed to gastric acid suppressants was also significantly different (p < 0.05) between the two groups. Multivariate analysis indicated that serum creatinine (OR 1.004; 95% CI 1.001-1.008), surgical intervention (OR 6.132; 95% CI 2.594-14.493), the number of comorbidities (OR 2.573; 95% CI 1.353-4.892), gastrointestinal disease (OR 4.670; 95% CI 2.002-10.895), and antibiotic use (OR 6.718; 95% CI 2.846-15.859) were independently associated with CDI. CONCLUSIONS This study revealed several risk factors for CDI among elderly hospitalized patients. These findings will increase the knowledge concerning this disease and provide information regarding the control and prevention of CDI in the elderly.