呼吸内科住院患者抗生素相关性腹泻的临床特征及危险因素分析

Clinical features and risk factors of antibiotic-associated diarrhea in patients admitted to department of respiratory medicine

目的分析呼吸内科住院患者抗生素相关性腹泻的临床特征及其危险因素。方法选择浙江省医疗健康集团杭州医院呼吸内科2018年1月至2019年12月应用抗生素治疗的1980例患者的临床资料,根据抗生素应用后是否出现抗生素相关性腹泻(AAD)分为AAD组和非AAD组,分析AAD的临床特征,并采用单因素和多因素logistic回归分析AAD的危险因素。结果1980例应用抗生素患者发生AAD者71例,发生率为3.59%。71例引起AAD的抗生素使用频率依次为:β-内酰胺类与酶抑制剂的复合制剂、第三代头孢、碳青霉烯类、第二代头孢。AAD临床表现主要为大便次数增多、大便性状改变。经单因素及多因素logistic回归分析,结果显示年龄、病重、住院时间、抗生素联合使用及使用时间是呼吸内科住院患者发生AAD的独立危险因素(均P<0.01)。结论缩短住院时间,合理选用抗生素,减少多种类型抗生素联合使用及避免长时间使用抗生素是减少AAD发生的重要预防措施。

Objective To investigate the clinical features and risk factors of antibiotic-associated diarrhea(AAD)in patients admitted to department of respiratory medicine.Methods The clinical data of 1980 patients who received antibiotics for infections in Department of Respiratory Medicine of our hospital between January 2018 and December 2019 were enrolled in the study.The clinical features were compared between patients with AAD(AAD group)and those without AAD(non-AAD group);and the risk factors of AAD were analyzed with univariate analysis and multivariate Logistic regression.Results Among 1980 patients,AAD occurred in 71 cases with an incidence rate of 3.59%.The most common antibiotics related to AAD was beta-lactam plus enzyme inhibitors,followed by the third generation of cephalospotins,carbapenem,and second generation of cephalospotins.The major clinical manifestations of AAD was increased stool frequency and the change of character of stool.The univariate analysis and multivariate logistic regression analysis showed that the age,seriously illl,length of hospital stay,combined use of antibiotics and the time of using antibiotic were independent risk factors of AAD(all P<0.01).Conclusion Shortening the length of hospital stay,rational use of antibiotics,reducing combined antibiotic use,and avoiding long-term antibiotic use are important measures to prevent or reduce the occurrence of antibiotic-associated diarrhea.