住院患者抗菌药相关性腹泻的临床研究

Clinical study on antibacterial-associated diarrhea in hospitalized patients

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 discuss the occurrence and risk factors of antibacterial-associated diarrhea（AAD） in hospitalized patients in order to provide rational antibacterial use for reference. Methods：Between December 1,2008 and November 30,2009,the data of patients with diarrhea from Beijing Anzhen Hospital,Capital Medical University were collected. According to their medical history and stool tests,the patients were divided into two groups：the antibacterial-associated diarrhea group （the AAD group） and the non-antibacterial-associated diarrhea group （the non-AAD group）. The clinical characteristics of patients,the situation of the antibacterial use,and the medical intervention measures were compared between the two groups; and the risk factors related to AAD were analyzed. Results：A total of 297 patients with diarrhea entered this study. The AAD group （n=194） comprised 101 male patients with average age of （69±14） years and 93 female patients with average age of （70±16） years. The non-AAD group （n=103） comprised 63 male patients with average age of （61±13） years and 40 female patients with average age of （65±12） years. The rates of patients with age of ≥60 years,number of ICU cases,≥21 days of a hospital stay,number of a fasting regimen,receiving medical interventions and intensive nursing care,were more in the AAD group than in the non-AAD group.They were 81.4% （158 cases） vs 69.9%（72 cases）,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% （34 cases）,30.4% （59 cases） vs 14.6% （15 cases） and 43.3% （84 cases） vs 28.1% （29 cases）,respectively （all P〈0.05）. The rates of patients receiving antibacterial treatment〉14 days and /or ≥2 antibacterial agents combined were more in the AAD group than in the non-AAD group. They were 43.3% （84 cases） vs 20.4% （21 cases ）,84.0% （163 cases） vs 53.4% （55 cases）,respectively （all P〈0.01）. The antibacterial agents frequently implicated in AAD were cephalosporins,cephamycins,compound-lactamase inhibitors,carbapenems,quinolones,and lincomycin. There was no statistically significant difference in the prognoses between the two groups. The risk factors for AAD included age of ≥60,medical interventions,14 days of antibacterial use,combined antibacterial therapy. Conclusion：Antibacterial-associated diarrhea is one of the common diarrhea in hospitalized patients. Therefore,long time antibacterials use and/or multiple antibacterial use should be avoided. Care should be taken in clinical use of antibacterial for the patients with advanced age,underlying diseases,and underlying fasting regimen and/or medical interventions.