本文選題：艱難梭菌　切入點(diǎn)：艱難梭菌相關(guān)性腹瀉　出處：《中南大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：(1)通過對某院ICU住院患者中發(fā)生抗生素相關(guān)性腹瀉的患者糞便進(jìn)行厭氧培養(yǎng),進(jìn)行細(xì)菌鑒定,了解艱難梭菌的感染情況。 (2)統(tǒng)計(jì)分析艱難梭菌相關(guān)性腹瀉與非艱難梭菌所致抗生素相關(guān)腹瀉的各種因素,明確兩者在危險(xiǎn)因素及臨床特征上的差異。 方法：對2012年10月-2013年3月某院ICU(包括中心ICU、神經(jīng)外科ICU、神經(jīng)內(nèi)科ICU、呼吸ICU、急診ICU)患者進(jìn)行前瞻性監(jiān)測。嚴(yán)格按照病例納入及排除標(biāo)準(zhǔn),對發(fā)生抗生素相關(guān)性腹瀉的患者進(jìn)行調(diào)查和大便標(biāo)本進(jìn)行艱難梭菌的厭氧培養(yǎng),并做菌株鑒定；對艱難梭菌腹瀉患者與非艱難梭菌所致抗生素相關(guān)腹瀉患者進(jìn)行分組,對各種因素進(jìn)行Chi-square檢驗(yàn)和t檢驗(yàn),分析臨床特征及危險(xiǎn)因素等方面的差異。 結(jié)果：調(diào)查的6個月期間,共有1322例ICU住院患者,納入抗生素相關(guān)性腹瀉患者82例,抗生素相關(guān)腹瀉發(fā)病率為6.2%(82/1322)；82例抗生素相關(guān)性腹瀉患者大便標(biāo)本中,培養(yǎng)出艱難梭菌8株,分離率為9.8%(8/82),該院ICU病房的ADCD發(fā)病率為61/100,000患者(8/1322)。82例發(fā)生抗生素相關(guān)性腹瀉的患者,男性56例(68.29%),女性26例(31.70%),平均年齡54.31±19.67歲,基礎(chǔ)疾病主要有腦出血19例(23.17%),惡性腫瘤16例(19.51%),重型肺炎13例(15.85%)。所有患者均使用過頭孢類、廣譜青霉素類、喹諾酮類、碳青霉烯類等廣譜抗菌藥物中的一種或多種,抗菌藥物平均使用時(shí)間為7.26±7.26天。對比兩組患者危險(xiǎn)因素：年齡、性別、抗生素使用種類、抗生素聯(lián)用情況、抗生素使用時(shí)間,是否使用質(zhì)子泵抑制劑等因素,均無統(tǒng)計(jì)學(xué)差異；對比兩組患者臨床特征：是否發(fā)熱、腹瀉次數(shù)、有無腹痛、嘔吐、血常規(guī)wbc是否升高等因素,均無統(tǒng)計(jì)學(xué)差異。 結(jié)論：該院ICU病房艱難梭菌相關(guān)性腹瀉發(fā)病率較低。艱難梭菌相關(guān)性腹瀉與非艱難梭菌所致抗生素相關(guān)腹瀉患者在危險(xiǎn)因素及臨床表現(xiàn)上,均無統(tǒng)計(jì)學(xué)差異,因此很難從危險(xiǎn)因素相關(guān)性及臨床表現(xiàn)上將兩者區(qū)分開來,病原檢測是區(qū)別艱難梭菌相關(guān)性腹瀉與其它抗生素相關(guān)性腹瀉的有效方法
[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 鹵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 鹵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.
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R515.9

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本文編號：1646982