益生菌制剂预防老年患者抗生素相关性腹泻

Use of Probiotics for Prevention of Antibiotic-associated Diarrhea in Elderly Patients

背景：抗生素相关性腹泻（AAD）是临床应用抗生素的常见并发症.目前益生菌制剂用于AAD的治疗已得到广泛认可.但其是否可用于预防AAD仍存在争议.目的：研究成年和老年住院患者的AAD发生率,以及益生菌制剂对老年患者AAD的预防作用.方法：根据入选标准连续纳入同期接受抗生素治疗的成年和老年住院患者,后者随机分为两组,分别予地农芽孢杆菌1.5×109 cfu/d干预至停用抗生素后1周或不予干预.分析各组抗生素使用情况和AAD发生率.结果：成年组与老年未干预组间、老年干预组与未干预组间抗生素使用情况均无明显差异.成年组AAD发生率明显低于老年未干预组（10.6%对27.4%,P=0.001）,老年干预组亦明显低于老年未干预组（13.6%对27.4%,p=0.01）.差异均有统计学意义.结论：老年患者为AAD高发人群,益生菌制剂与抗生素同时应用可有效减低老年住院患者的AAD发生率.可作为AAD预防措施应用于临床.

Antibiotic-associated diarrhea （AAD） is a commonly seen complication of antibiotic therapy in clinical practice. Use of probiotics in the treatment of AAD has been well recognized; however, its preventive effect on AAD remains controversial. Aims： To investigate the occurrence rate of AAD in adult and elderly inpatients, and the efficacy of probiotics in the prevention of AAD in elderly patients. Methods： Consecutive adult and elderly inpatients taken antibiotic therapy and fulfilled the inclusion criteria were enrolled. The elderly patients were randomized into two groups, one group reeeived Bacillus lieheniformis 1.5×109 efu/d until one week after cessation of antibiotic therapy, and the other without any intervention. The use of antibiotics and occurrence of AAD were analyzed in these groups. Resuils： No statistical difference was found in the use of antibiotics between adult patients and elderly non-intervention patients, as well as between elderly probiotics-intervention patients and elderly non-intervention patients. The occurrence rate of AAD in elderly non-intervention patients was significantly higher than that in adult patients （27.4% vs. 10.6%） and higher than that in elderly probiotics-intervention patients （27.4% vs. 13.6%）, the differences were statistically significant （P=0.001 and P=0.01, respectively）. Conclusions： Elderly patients are more prone to AAD as compared with adult patients. Simultaneous use of probiotics with antibiotic can effectively reduce the occurrence rate of AAD in elderly inpatients, which suggests that probioties can be used as a preventive measure against AAD.