The Analysis Of Risk Factors And Incidence Of Clostridium Difficile Infection In ICU

Objective: Know about the incidence and prevalence of antibiotic-associated diarrhea(AAD)and Clostridium difficile-associated diarrhea(CDAD)in intensive care units(ICUs)in our hospital from June 2017 to August 2018.Retrospectively analyze the risk factors of Clostridium difficile infection in ICU and provide some evidence of diagnosis and treatments for CDI in ICU.Methods: We investigated the hospitalized patients with watery diarrhea in each ICU(including respiratory ICU,neurosurgical ICU,neurological ICU,cardiac surgery ICU and general ICU)from June 2017 to August 2018 and 59 cases of patients with watery diarrhea were screened out according to inclusion criteria and exclusion criteria,whose fecal specimens were then collected and placed in a sterile container and sent to the laboratory within 2 hours for tests.Meriere mini VIDAS automatic analyzer was used for the detection of C.difficile toxin A and B and Xpert C.difficile PCR was used for the detection of C.difficile-related virulent genes.Isolation,identification and culture of Clostridium difficile from fecial specimens were then conducted and toxigenic culture(TC)was performed if either toxinA and B or virulent genes are positive.The application of miniVIDAS and Xpert C.difficile PCR in rapid detection of Clostridium difficile in stool specimens was evaluated by TC seen as a gold standard.Based on the test results and the diagnostic criteria for CDI released in 2017 by SHEA and IDSA,we diagnosed CDI-cases.Divede all recipents into CDI group and non-CDI group and retrospectively collect their medical records for analysis of risk factors.All statistical analysis were performed using the SPSS version 20.0.The chi-square test(or fisher’s exact test as appropriate)was applied to the compared categorial variables described as frequencies with percentage and t test(wilcoxon rank-sum test where appropriate)were used to compare the numerical data expressed as meidans with interquartile.Variables found to be statistically significant by a univariate analysis were then entered into a multivariate logistic regression analysis to identify independent risk factors relevant to CDI status.P-value﹤0.05 was considered significant.Results:Meriere mini VIDAS automatic analyzer had the following results: sensitivity,70%;specificity,100%;positive predictive value(PPV),100%,negative predictive value,94.2%;the sensitivity,specificity,PPV and NPV of the Xpert C.difficile assay are all100%.10 strains of C.difficile were isolated from 59 diarrhea specimens in ICU and thepositive rate was 16.9%(10/59).1 recipent had not received any antibiotics before one month of tests and the positive rate of AAD in ICU was 1.6%(58/3602).3 genetic test positive results were inconsistent with toxinic test results and no 027 type of highly virulent CD strains was found.Univariate analysis indicated that the use of gastrointestinal motility drugs,serum potassium and vancomycin may may be associated with the occurrence of CDI(P<0.05).Multivariate analysis indicated that vancomycin(OR=0.074,95%CI.:0.006-0.862,p=0.038)was a protective factor and gastrointestinal motility drug(OR=17.189,95%CI.:1.392-212.296,p= 0.027)was a risk factor for CDI.Conclusions: The incidence of AAD in ICU in our hospital is lower relatively and the mortality and morbility of CDAD are higher,so the clinicians in ICU should pay more attention to CDI,strengthen the monitoring of CDI and the tests for CDI can be considered as a routine examination for AAD patients.Whether the gastrointestinal molitity drug is a risk factor for CDI needs a further study.