结核病患者艰难梭菌感染的风险因素剖析OA

Objective Patients with tuberculosis(TB)are at potential risk for Clostridioides difficile infection(CDI)due to their clinical characteristics.This study aimed to identify independent risk factors for CDI in TB patients,providing evidence-based support for CDI prevention,control and management in this population.Methods This retrospective case-control study utilized data from the TB-specific database of Beijing Chest Hospital,from January 2022 to December 2024.A total of 110 patients were enrolled(CDI group,n=60;non-CDI group,n=50).Univariate and multivariate logistic regression assessed associations of CDI with nutritional indices(NRS2002 score,serum albumin),anti-TB drugs(rifampin),broad-spectrum antibiotics(carbapenems),and clinical characteristics(age,hospitalization duration,severe TB).Results Multivariate logistic regression identified that elevated serum albumin can reduce the risk of CDI in tuberculosis patients(OR=0.817,P=0.010),which is an independent protective factor,NRS2002 score(OR=1.975,P=0.001),carbapenem use(OR=5.815,P=0.042),older age(OR=1.046,P=0.045),rifampin use(OR=6.588,P=0.028),and hospitalization duration longer(OR=1.285,P=0.001).Severe TB and comorbid diabetes were not associated with CDI after adjustment(P>0.05).Conclusions Hypoalbuminemia,elevated NRS2002 score(high nutritional risk),carbapenem use,advanced age,and rifampin use are core independent CDI risk factors in TB patients.Pathogenesis involves synergism of impaired nutritional barrier,gut microbiota perturbation,and age-related immunosenescence.These findings provide evidence-based support for CDI risk identification,early warning,and precise prevention and control of CDI in TB patients.