细菌性重症肺炎患儿抗生素相关性腹泻发病率及高危因素分析

Incidence and risk factor analysis of antibiotic-associated diarrhea of pediatric patients with severe bacterial pneumonia

目的探讨细菌性重症肺炎患儿抗生素相关性腹泻（AAD）的发生率及高危因素。方法收集2011年1月—2014年1月1 086例入院时未经抗生素治疗且无腹泻的细菌性重症肺炎患儿的临床资料,回顾性分析患儿AAD发生率及导致AAD发生的高危因素。结果 1 086例细菌性重症肺炎患儿AAD发生率为36.74%。多因素logistic回归分析结果显示,年龄≤2岁（OR=4.53,95%CI：2.38-8.85）,有机械通气（OR=1.69,95%CI：1.23-3.99）,抗生素联用（OR=4.75,95%CI：2.39-8.99）,使用阿莫西林/克拉维酸（OR=3.24,95%CI：1.09-5.67）、哌拉西林/他唑巴坦（OR=3.68,95%CI：1.30-4.32）、头孢哌酮/舒巴坦（OR=3.98,95%CI：1.08-3.84）均为AAD发生的独立危险因素。结论细菌性重症肺炎患儿年龄≤2岁、有机械通气、联用抗生素、使用β-内酰胺类/β-内酰胺酶抑制剂均是AAD的高危因素。

Objective To investigate the incidence and risk factors of antibiotic-associated diarrhea （AAD） of pediatric patients with severe bacterial pneumonia. Methods Clinical data of 1086 pediatric patients with severe bacterial pneumonia from January 2010 through January 2014 were recruited. The incidence and risk factors of AAD were retrospectively analyzed. Results The incidence of AAD in 1086 pediatric patients with severe bacterial pneunaonia was 36.74%. The incidence of AAD in patients younger than 2 years old were higher than that in those older than 2 years, once or more times of mechanical venti- lation history were higher than that with no arrangements of this treatment, administering of combined antibiotics therapy were higher than that with single antibiotics, and the incidence of AAD due to amoxicillin/clavulanate, piperacillin/tazobactam, cefo- perazone/sulbactam in pediatric patients were 43.55%, 43.75%, and 45.03%, respectively. Three β-lactam/β-lactamase inhibitors above were risk factors of AAD through multivariate Logistic regression analysis. Conclusion The high incidence of AAD in pediatric patients with severe bacterial pneumonia was associated with some risk factors, including younger than 2 years old, mechanical ventilation, combined antibiotics therapy and administration of β-lactam/β-lactamase inhibitor （amoxicillin/clavulanate, piperacillin/tazobactam, cefoperazone/sulbactam）.