内科理论与实践

内科理论与实践 >

2025 , Vol. 20 >Issue 03: 216 - 223

DOI: https://doi.org/10.16138/j.1673-6087.2025.03.06

论著

艰难梭菌毒素阳性延长急诊重症患者住院时间并增加费用

  • 虞美玲 ,
  • 李娇琰 ,
  • 黎健 ,
  • 陈影 ,
  • 赵冰 ,
  • 毛恩强 ,
  • 杨之涛
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  • 上海交通大学医学院附属瑞金医院急诊科，上海 200025
杨之涛 E-mail：yangzhitao@hotmail.fr

收稿日期: 2025-04-14

  网络出版日期: 2025-09-01

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Clostridioides difficile toxin positivity prolongs hospital stay and increases costs for critically ill patients in emergency patients

  • YU Meiling ,
  • LI Jiaoyan ,
  • LI Jian ,
  • CHEN Ying ,
  • ZHAO Bing ,
  • MAO Enqiang ,
  • YANG Zhitao
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  • Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China

Received date: 2025-04-14

  Online published: 2025-09-01

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摘要

目的：研究重症监护室患者中粪便艰难梭菌毒素检测阳性对临床预后的影响及危险因素。 方法：方法：回顾性分析2013—2022年间上海交通大学医学院附属瑞金医院急诊重症监护室收治的2 036例患者，比较粪便艰难梭菌毒素检测阳性组（n=225）与阴性组（n=1 811）的临床预后。采用多因素Logistic回归分析艰难梭菌毒素阳性的危险及保护因素。 结果：粪便检测艰难梭菌毒素检测阳性组患者住院时间显著延长（B=18.734 d，95%CI：14.683~22.785），治疗费用明显升高（B=68 854.912元， 95%CI ：46 579.159~91 130.665），但2组死亡率差异无统计学意义。多因素分析显示，碳青霉烯类抗菌药物（OR=1.58，95%CI：1.16~2.15），血流感染（OR=1.77，95%CI： 1.17~2.66）和胆道感染（OR=1.79，95%CI ：1.03 ~3.10）与粪便艰难梭菌毒素检测阳性率升高呈相关性，而甲硝唑使用（OR=0.58，95%CI ：0.40~0.84）、头孢菌素抗菌药物使用（OR=0.54，95%CI： 0.39~0.74）以及女性（OR=0.60，95%CI ：0.44~0.83）是保护因素。 结论：危重症患者粪便中艰难梭菌毒素检测阳性不增加患者死亡率，但会延长住院时间，增加住院费用。

关键词： 艰难梭菌; 重症监护室; 抗菌药物管理; 感染预防

本文引用格式

虞美玲 , 李娇琰 , 黎健 , 陈影 , 赵冰 , 毛恩强 , 杨之涛 . 艰难梭菌毒素阳性延长急诊重症患者住院时间并增加费用[J]. 内科理论与实践, 2025 , 20(03) : 216 -223 . DOI: 10.16138/j.1673-6087.2025.03.06

Abstract

Objective To explore the influence of Clostridioides difficile (C. difficile)positivity on clinical outcomes and identify associated risk factors in intensive care unit（ICU） patients. Methods A retrospective analysis was conducted on 2 036 patients admitted to the emergency ICU of Ruijin Hospital from 2013 to 2022, comparing outcomes between C. difficile-positive (n=225) and C. difficile negative (n=1 811) groups. Multivariate regression analysis was used to identify risk and protective factors. Results Significantly prolonged hospital stays (B=18.734 d, 95% CI: 14.683-22.785) and higher treatment costs (B=68 854.912, 95% CI: 46 579.159-91 130.665) in the C. difficile-positive group, with no statistically significant difference in mortality between groups. Multivariate analysis identified carbapenem use (OR=1.58, 95% CI: 1.16-2.15), bloodstream infection (OR=1.77, 95% CI: 1.17-2.66), and biliary tract infection (OR=1.79, 95% CI: 1.03-3.10) as risk factors for C. difficile positivity. Protective factors included metronidazole use (OR=0.58, 95% CI: 0.40-0.84), cephalosporin use (OR=0.54, 95% CI: 0.39-0.74), and female sex (OR=0.60, 95% CI： 0.44-0.83). Conclusions C. difficile positivity in critically ill patients did not affect mortality but prolonged hospitalization and increased costs. Both risk and protect factors for C. difficile are identified.

Key words： Clostridioides difficile; Intensive care unit; Antimicrobial stewardship; Infection prevention

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