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目的:探讨住院患者抗菌药相关性腹泻(AAD)的发生情况及危险因素,为合理应用抗菌药提供参考。方法:收集2008年12月1日至2009年11月30日在首都医科大学附属北京安贞医院住院后发生腹泻患者的临床资料,根据病史及粪便检查结果将其分为AAD组和非AAD组,比较2组患者的基本特征、接受医疗干预措施和抗菌药使用等情况,分析AAD的相关危险因素。结果:297例腹泻患者分为AAD组(194例)和非AAD组(103例)。AAD组男性101例,平均年龄(69±14)岁;女性93例,平均年龄(70±16)岁;非AAD组男性63例,平均年龄(61±13)岁;女性40例,平均年龄(65±12)岁。AAD组年龄≥60岁、住监护室、住院时间≥21d、禁食、接受侵袭性操作和特级护理者比例均明显高于非AAD组[分别为81.4%(158例)比69.9%(72例)、47.4%(92例)比35.9%(37例)、37.1%(72例)比19.4%(20例)、49.0%(95例)比33.0%(34例)、30.4%(59例)比14.6%(15例),43.3%(84例)比28.1%(29例),均P<0.05]。AAD组使用抗菌药时间>14d、联合应用≥2种抗菌药者比例均明显高于非AAD组[分别为43.3%(84例)比20.4%(21例)、84.0%(163例)比53.4%(55例),均P<0.01]引起AAD的抗菌药主要为头孢菌素及头霉素类、酶抑制剂复合物、碳青霉烯类、喹诺酮类和林可霉素类。2组患者的预后差异无统计学意义。年龄≥60岁、接受医疗干预措施、使用抗菌药时间>14d、联合应用≥2种抗菌药是住院患者发生AAD的相关危险因素。结论:AAD是住院患者常见腹泻原因之一。老年及(或)伴有基础疾病、住院期间禁食及(或)接受侵袭性操作、较长时间应用抗菌药及(或)应用多种抗菌药者易发生AAD,临床医师对上述患者应谨慎使用抗菌药。
Objective: To investigate the occurrence and risk factors of antibacterial drug-associated diarrhea (AAD) in hospitalized patients and provide reference for rational use of antibacterials. Methods: The clinical data of patients with diarrhea who were hospitalized in Beijing Anzhen Hospital, Capital Medical University from December 1, 2008 to November 30, 2009 were collected and divided into AAD group and non-AAD group according to their medical history and stool examination results , Comparing the basic characteristics of two groups of patients, receiving medical interventions and the use of antibacterials and so on, to analyze the related risk factors of AAD. Results: 297 diarrhea patients were divided into AAD group (194 cases) and non-AAD group (103 cases). There were 101 males in the AAD group, with an average age of 69 ± 14 years; 93 females with an average age of 70 ± 16 years; 63 males (63 ± 13) years of age in the non-AAD group, 40 females with an average age (65 ± 12) years old. In the AAD group, patients aged 60 years or older, residential care units ≥21 days, fasting, invasive procedures and super care were significantly higher in the AAD group than in the non-AAD group (81.4% vs 158.9% versus 72.9%, respectively) ), 47.4% (92 cases) vs 35.9% (37 cases), 37.1% (72 cases) vs 19.4% (20 cases), 49.0% (95 cases) vs 33.0% More than 14.6% (15 cases), 43.3% (84 cases) vs 28.1% (29 cases), all P <0.05]. In the AAD group, the use of antibacterials for more than 14 days combined with ≥2 antibacterials were significantly higher in the AAD group than in the non-AAD group (43.3% vs 84.4% vs 20.4%, 84.0% vs 163.4%, respectively) % (55 cases), all P <0.01]. The main antibacterial agents of AAD were cephalosporin and cephamycin, enzyme inhibitor complex, carbapenems, quinolones and lincomycin. There was no significant difference in prognosis between the two groups. Age ≥60 years of age, receiving medical interventions, the use of antibacterials for more than 14 days, combined use of ≥2 kinds of antibacterials is associated with hospitalized patients with AAD risk factors. Conclusion: AAD is one of the common causes of diarrhea in hospitalized patients. AAD is prone to occur in the elderly and / or associated with underlying diseases, fasting and / or invasive procedures during hospitalization, prolonged use of antimicrobials, and / or use of multiple antimicrobials, and clinicians should be cautious in these patients Use antibacterials.