| Objective: To explore the status of hospitalized diarrhea patients who have Clostridium difficile infection with different causes;to compare the differences of infection rate;to understand the relationship between Clostridium difficile infection and diarrhea,and the potential danger of Clostridium difficile infection.Methods: 101 hospitalized patients were collected as the experimental group from the first affiliated hospital of Dalian Medical University from the department of digestion and ICU in May 2017 to October 2018.According to the patient's history,signs,laboratory examination and imaging examination,patients were divided into acute enteritis group(24 cases),irritable bowel syndrome group(19 cases),proton pump inhibitor group(24 cases),antibiotic associated diarrhea group(18 cases)and liver cirrhosis group(16 cases).At the same time,30 healthy patients were compared to as the control group.Fecal specimens and clinical data of the patients were collected,including age,sex,basic disease,medical history,drug use,laboratory examination,colonoscopy results,diagnosis and treatment outcome.All subjects and controlled patients had their clostridium difficile toxin B tested through the enzyme-linked immunosorbent experiment.At the same time,the fecal bacillus culture and smear microscopy stool ball/Bacillus ratio were examined.Each of the experimental groups were analyzed(acute enteritis group,irritable bowel syndrome Group,proton pump inhibitor group,antibiotic-associated diarrhea Group,cirrhosis Group)and were compared to the healthy controlled group in the cultivation of fecal pellets and smear microscopy.The clinical characteristics of patients with antibiotic-related diarrhea were analyzed retrospectively.Results:1.Comparison of age and gender composition in each group.The healthy control group was composed of a total of 30 patients,including 8 males(26.7%),22 females(73.3%),aged 31-74,with an average of 58.6±10.63.The acute enteritis group was composed of 24 patients,including 8 males(33.3%)and 16 females(66.7%),aged 48~79,with an average of 61.00±10.03.The irritable bowel syndrome group was composed of 18 patients,including 6 males(31.6%)and 13 females(68.4%),aged 34~86,with an average of 61.32±12.44.The proton pump inhibitor group was composed of 24 patients,including 6 males(25%)and 18 females(75%),aged 44~78 years,with an average of 64.00±9.59.Antibiotic associated diarrhea group was composed of 18 patients including 4 males(22.2%),14 females(77.8%),aged 65~90,with an average of 82.17±5.72.The cirrhosis group was composed of 16 patients,including 7 males(43.8%)and 9 females(56.3%),aged 30-80,with an average of 58.94±11.98 years.There was no difference in the gender composition between the experimental group and the healthy controlled group(P?0.05).The average age of antibiotic associated diarrhea group was obviously higher than that of the healthy controlled group(P<0.05).Furthermore the average age of the antibiotic associated diarrhea group had significant differences compared to that of the other groups in the experimental group(P<0.05).However,the other four groups in the experimental group(acute enteritis,irritable bowel syndrome group,proton pump inhibitors,cirrhosis group)had no variations of average age(P>0.05).2.Results of fecal microscopy smear and fecal culture.The fecal culture showed no growth of Shigella,salmonella or other pathogenic bacteria.Results of the examinations for fecal smear and fecal ball/bacillus proportion show that the acute enteritis group,the irritable bowel syndrome Group,the proton pump inhibitor group,the antibiotic associated diarrhea group and cirrhosis group were 33.3%,36.8%,58.3%,77.8% and 50%.The results were considerably higher than the Health control group(10%).The difference was statistically significant(P<0.05).3.Comparison of the infection rate of clostridium difficile between the experimental group and the healthy controlled group.In the healthy controlled group,30 patients were tested positive for clostridium difficile toxin,with a rate of 3.3%.The positive rate of clostridium difficile toxin in proton pump inhibitor group,antibiotic associated diarrhea group and liver cirrhosis group were 20.8%,27.8% and 25%.The results were significantly different from the healthy controlled group(all P<0.05).The positive rate of clostridium difficile toxin in the acute enteritis group was 16.7%,and the positive rate of clostridium difficile toxin in the irritable bowel syndrome group was 10.5%,both results were considerably higher than that in the healthy control group,but the difference has no statistical significance.(P > 0.05).4.Comparison of the infection rate of clostridium difficile between the experimental groups.The positive rates of Clostridium difficile toxin in acute enteritis group,irritable bowel syndrome Group,proton pump inhibitor group,antibiotic-associated diarrhea group and cirrhosis group were 16.7%,10.5%,20.8%,27.8% and 25%.The positive rate of antibiotic-associated diarrhea group was the highest,the positive rate of irritable bowel Syndrome Group was the lowest.However,there was no significant difference between the groups(P>0.05).5.Clinical characteristics of antibiotic-associated diarrhea.18 patients with antibiotic-related diarrhea,with an average age of 82.17±5.72 years old,were hospitalized for more than 15 days.Nasal feeding was received by 8 patients,all of which were combined with one or more basic diseases.Among which 12(67%)basic diseases were combined with two or more.All patients were treated with more than one antibiotic.The duration of the antibiotic treatments ranged from 2 days to 2 months.The antibiotics included mainly beta-lactam,quinolones,carbapenems,penicillin and cephalosporins.Diarrhea averagely started on the(11±8)day.The patients defecated 3-9 times a day on average.6 patients(33.3%)showed mucous loose stools.3 patients(16.7%)showed mucous blood stools,accompanied by fever,abdominal distension and colic of different degrees.The total number of white blood cells and the proportion of neutrophils increased.5 patients(27.8%)were positive for clostridium difficile toxin.Conclusions:1.The infection rate of clostridium difficile increased in diarrhea patients.2.Risk of clostridium difficile infection increased for patients with antibiotic exposure,proton pump inhibitors use,and liver cirrhosis.3.Clostridium difficile infection rates are highest in antibiotic-related diarrhea.Age may be an important risk factor for clostridium difficile infection. |
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