重症细菌性肺部感染儿童抗生素相关性腹泻状况调查

Investigation of Antibiotic Associated Diarrhea Situation in Children with Severe Bacterial Lung Infection

目的探讨重症细菌性肺部感染儿童抗生素相关性腹泻（AAD）的发病情况。方法选取医院2012年2月至2013年10月收治的重症细菌性肺部感染患儿110例,将其中发生AAD的作为观察组,未发生AAD的作为对照组。回顾性分析两组患儿的临床资料,包括患儿的年龄、抗菌药物应用类型及应用时间、血中性粒细胞水平、血红蛋白量、住院时间等。结果 110例患儿中,74例（67.27%）发生AAD,36例（32.73%）未发生AAD。单因素分析结果显示,重症肺部感染患儿的年龄越小、抗菌药物应用时间越长、血中性粒细胞比例越高、血红蛋白量越高、住院时间越短,患儿AAD的发生率越高（χ2=4.325~7.774,P〈0.05）;常见抗菌药物引发AAD的几率为,头孢菌素类〉青霉素类〉大环内酯类（χ2=8.635,P=0.013）。多因素Logistic回归分析筛选出4个危险因素,即发病年龄、抗菌药物应用时间、住院时间和抗菌药物类型。AAD患儿经停用或更换抗菌药物后,39例（52.70%）腹泻于7 d内痊愈,31例（41.89%）好转。结论重症细菌性肺部感染患儿AAD的发生率较高,与患儿的年龄、抗菌药物应用种类、应用时间及住院时间等有关。

Objective To investigate the incidence situation of antibiotic associated diarrhea（ AAD） in children with severe bacterial lung infection. Methods 110 children patients with severe bacterial lung infection in our hospital from February 2012 to October 2013 were selected. Among them,the cases of AAD occurrence were taken as the observation group and the other cases without AAD occurrence as the control group. The clinical data of the two groups were retrospectively analyzed,including the age,type of used antibacterials,application time,blood neutrophils level,hemoglobin and hospitalization time. Results Among 110 investigated cases,ADD occurred in 74cases（ 67. 3%） and 36 cases（ 32. 7%） had no ADD occurrence. The single factor analysis results showed that the younger the age,the longer the time of antibiotic use,the higher the blood neutrophil percentage,the higher the hemoglobin amount and the shorter the hospital stay,the higher the occurrence rate of AAD was（ χ2 = 4. 325- 7. 774,P 0. 05）. The probability of antibacterials caused ADD was cephalosporins penicillin macrolides（ χ2 = 8. 635,P = 0. 013）. The multivariate Logistic regression analysis further screened out 4risk factors： age of onset,time of antibacterials use,hospital stay and type of antibacterials. After antibacterials withdrawal or changing the antibacterials types in AAD,39 cases（ 52. 70%） of ADD were cured within 7 d and 31 cases（ 41. 89%） were improved. Conclusion The incidence of AAD in children with severe bacterial lung infection is higher,which is related with the age,type of used antibacterials,application time and hospitalization time.