高龄老年患者抗生素相关性腹泻的临床观察及易感因素分析

Clinical observation and susceptible factors of antibiotic associated diarrhea in elderly patients

目的分析使用抗生素的高龄老年住院患者发生抗生素相关性腹泻(antibiotic associated diarrhea,AAD)的危险因素,为有效预防老年AAD的发生提供防治策略。方法回顾性分析2018年1月至2019年6月入住复旦大学附属华山医院老年医学科的应用抗生素治疗的高龄老年患者资料,根据诊断标准和入选标准,共收集158例患者资料,记录患者的年龄、临床资料等,对所有患者进行aCCI评估和GNRI评估。其中AAD患者49例,为AAD组,其余109例患者为非AAD组。结果两组患者在共病指数、营养风险指数、长期卧床及抗生素使用种类和抗生素使用时间方面相比,差异有统计学意义(P<0.05)。aCCI高得分和使用含有酶抑制剂的抗生素是高龄老年住院患者发生AAD的独立高危因素。结论aCCI高得分、GNRI<98分、长期卧床及连续性抗生素使用时间过长和使用抗生素酶抑制剂合剂是高龄老年住院患者AAD的高危因素。

Objective To analyze the risk factors of antibiotic associated diarrhea(AAD)in elderly inpatients using antibiotics,and provide prevention and control strategies for the effective prevention of AAD in the elderly.Methods The data of the elderly patients who were treated with antibiotics in the Department of Geriatrics of Huashan Hospital Affiliated to Fudan University from Jan.2018 to Jun.2019 were analyzed retrospectively.According to the diagnostic criteria and inclusion criteria,158 patients were collected,and the age and clinical data of the patients were recorded.All patients were assessed with the aCCI and GNRI.Among them,49 patients with antibiotic associated diarrhea were in AAD group,and the other 109 patients were in non-AAD group.Results There were significant differences between the two groups in the comorbidity index,nutritional index,long-term bed rest,types of antibiotic use and antibiotic use time(P<0.05).The aCCI comorbidity index and the use of enzyme inhibitor mixture were independent risk factors of AAD in elderly inpatients.Conclusion The high risk factors of AAD in elderly inpatients are high comorbidity index,GNRI<98,long-term bed rest,long-term continuous antibiotic use and antibiotic enzyme inhibitor mixture.