老年腹泻患者监测结果分析

Analysis of monitoring results of elderly patients with diarrhea

目的 了解年龄≥60岁老年人感染性腹泻病原学特征和门诊抗菌药物相关性腹泻(antibiotic associated diarrhea, AAD)发生现状,为该病的防控决策提供依据。方法 收集2016年1月-2019年12月吴淞中心医院肠道门诊老年人腹泻病数据资料,按1∶8的比例采集粪便标本进行细菌和病毒检测。对老年人感染性腹泻病原体检出情况、时间分布特点、腹泻就诊时间、频次、食物种类和门诊ADD发生现状进行统计分析。采用χ^(2)检验对不同年度和各月份检出率进行差异性比较,P<0.05为差异有统计学意义。结果 共采集粪便标本1 022例,阳性标本为236份,检出菌毒株240株,总检出率为23.48%。其中病毒阳性标本80份,病毒83株,检出率为8.12%,主要以诺如病毒和轮状病毒感染为主。细菌阳性标本156份,细菌157株,检出率为15.36%,各年份细菌检出率差异有统计学意义(χ^(2)=13.17,P<0.05)。主要以肠毒性大肠杆菌(ETEC)、非伤寒沙门氏菌和空肠弯曲菌感染为主。老年人腹泻频次以5~9次/d占比最高,为50.00%;腹泻1 d来院就诊的比例最高为55.08%。食用肉及肉制品、果蔬类和海水产品导致的腹泻占比高。老年人ADD发生率为5.77%,以≥70岁为主,女性多于男性。抗菌药种类以喹诺酮类、头孢类为主。结论 感染性腹泻和ADD是老年人疾病预防的重点,应采取有针对性防治措施。

Objective To understand the etiological characteristics of infectious diarrhea and the current status of outpatient antibiotic-associated diarrhea(AAD)in elderly patients aged≥60 years,so as to provide evidence for prevention and control of the disease.Methods The data of elderly patients with diarrhea treated in Intestinal Outpatient Department of Wusong Central Hospital from January 2016 to December 2019 were collected.Their fecal samples were collected at a ratio of 1∶8 for bacterial and viral testing.The detection of infectious diarrhea pathogens,temporal distribution characteristics,time and frequency of diarrhea visits,food types and current status of outpatient ADD occurrence in the elderly were analyzed statistically.χ^(2) test was used to compare the difference in detection rates of different years and months,and P<0.05 was considered statistically significant.Results A total of 1022 faecal samples were collected,236 positive samples were found and 240 strains of bacteria and viruses were detected,with a total detection rate of 23.48%.Among them,there were 80 positive samples and 83 strains of virus,with a detection rate of 8.12%,mainly norovirus and rotavirus.There were 156 bacteria positive samples and 157 strains of bacteria,with a detection rate of 15.36%.There was statistical significance in the bacterial detection rate among different years(χ^(2)=13.17,P<0.05).The main infected bacteria were ETEC,non-typhoid Salmonella and Campylobacter jejuni.The frequency of diarrhea in the elderly was highest at 5-9 times/d,accounting for 50.00%.The highest proportion of patients who come to hospital for treatment after one day of diarrhea was 55.08%.The consumption of meat and meat products,fruits and vegetables,and seawater products accounts for a high proportion of diarrhea.The incidence of ADD in the elderly was 5.77%,and most of them were≥70 years old,with more females than males.The main antibacterial drugs were quinolones and cephalosporins.Conclusion Infectious diarrhea and ADD are the key points for disease prevention in the elderly,and targeted prevention and treatment measures should be taken.