抗生素相关性腹泻296例流行病学及临床分析

Epidemiology and clinical characteristics of 296 inpatients with antibiotic-associated diarrhoea

目的了解住院患者抗生素相关性腹泻(AAD)的罹患率、危险因素、潜伏期、临床特点及预后.方法对我院普通病区及老年病区1234例抗生素应用者,自抗生素应用之日起,进行为期30 d的前瞻性追踪观察.结果抗生素应用者的AAD罹患率为24.00%(296/1234例);老年病区为29.46%,明显高于普通病区的17.30%(P＜0.01);老年患者为27.97%,明显高于中青年患者的11.03%(P＜0.01).AAD主要危险因素是广谱抗生素、高龄和危重症.AAD的潜伏期为0.5～28.0 d,平均为(8.49±5.36)d(中位数7.0 d),中青年患者平均为(10.25±5.19)d(中位数8.5 d),明显长于老年患者的(8.28±5.34)d(中位数7.0 d,P＜0.05).大多数患者病情较轻,预后良好;重症病例较少见,均为老年病例,病情凶险,死亡率高.296例AAD患者经停用或换用抗生素,应用微生态剂、甲硝唑或万古霉素等处理,痊愈178例(60.14%),好转72例(24.32%),无效40例(13.51%),死亡6例(2.03%).结论 AAD是一种常见的抗生素治疗的并发症,在老年病区和老年患者中发病率较高,绝大多数患者经适当处理预后良好;重症病例较少见,但死亡率高.

Objective To study the incidence,risk,factors ,incubation period, clinical characeristics and prognosis of antibiotic-associated diarrhoea （AAD）. Methods One thousand two hundred and thirty four patients received antibiotics were prospectively tracked and observed for 30-days in the common ward and geriatric ward of Huadong hospital, from beginning of antibiotic was given. Results The incidence of AAD was 24.00% in Huadong hospital, and that of inpatients in geriatric ward （29.46 %） was higher than that in the common ward （17. 30% ）, and that among the elderly patients （27.97 % ） was higher than that of the young and middle-aged patients （11.03 %）, P〈0.01. The main risk factors of AAD were broad-spectrum antibiotics, advanced age and serious sign and sysptom. The incubation period of AAD was 0.5-28.0 days （mean 8.49±5.36 days, median 7.0 days）. The incubation period of AAD in the young and middle-aged patients （mean 10.25 ± 5.19 days, median 8.5 days） was longer than that of the elderly patients （mean 8.28±5.34 days, median 7.0 days）, P〈0.05. The clinical presentation of AAD in most cases was mild with good prognosis . The serious cases were relatively few, all of them were elderly patients with high mortality. By discontinuation of the antibiotic or changing antibiotics, and utilized metronidazole or vancomycin and probiotic agents; 178 cases （60. 14 % ） recovered, 72 cases （24.32 %） improved, 40 （13.51%） failed and 6 cases （2.03 %） deteriorated and died. Conclusions AAD is a frequent com plication of antibiotic therapy, the incidence is relatively high among the elderly patients in the geriatric ward. Prognosis of most patients is good under proper management. Serious cases are few, but with high mortality. （Shanghai Med J, 2005,28：1014-1017）