ICU老年重症患者抗生素相关性腹泻的关联因素分析

Factors associated with antibiotic-associated diarrhea in elderly critically ill patients

背景抗生素相关性腹泻(antibiotic-associated diarrhea,AAD)是指使用抗生素后出现的无法用其他原因解释的腹泻。老年重症患者抗生素使用种类繁多,导致其发生AAD风险显著升高,但关于老年重症患者发生AAD的相关因素分析报道极少。目的分析使用抗生素的ICU老年重症患者发生抗生素相关性腹泻的关联因素。方法回顾性收集2020年1月1日—2022年6月30日入住解放军总医院第一医学中心重症医学科老年患者的临床资料,分析老年重症患者抗生素相关性腹泻的关联因素。结果共收集815例老年患者的临床资料,其中AAD患者125例,非AAD组患者690例。与非AAD相比,AAD组年龄调整的查尔森合并症指数(age-adjusted Charlson comorbidity index,aCCI)和序贯器官衰竭评分(sequential organ failure assessment,SOFA)更高,并且3代头孢抗生素、氟氧头孢、碳青霉烯类抗生素、糖肽类抗生素、哌拉西林他唑巴坦钠及抗真菌药物使用率更高(P<0.05)。与非AAD组相比,AAD组有着更高的病死率(P<0.05)。多因素Logistic回归分析结果提示气管切开(OR=7.227,95%CI:2.147~24.326,P=0.001)、连续肾脏替代治疗(OR=4.529,95%CI:1.344~15.258,P=0.015)、C反应蛋白水平高(OR=1.125,95%CI:1.019~1.241,P=0.019)、脂肪酶水平高(OR=1.005,95%CI:1.001~1.005,P=0.015)、a CCI高(OR=1.706,95%CI:1.373~2.121,P<0.001)、使用哌拉西林他唑巴坦(OR=4.040,95%CI:1.405~11.622,P=0.010)、3代头孢(OR=6.787,95%CI:2.791~16.506,P<0.001)、碳青霉烯类(OR=5.714,95%CI:1.874~17.425,P=0.002)、利尿剂(OR=9.098,95%CI:5.131~16.131,P<0.001)的老年重症患者发生AAD的风险更高。结论气管切开、连续肾脏替代治疗、C反应蛋白、脂肪酶、a CCI、哌拉西林他唑巴坦钠、3代头孢抗生素、碳青霉烯类抗生素、利尿剂使用是老年重症患者发生AAD的独立关联因素,临床医生应当重视对这类患者的前瞻性预防。

Background Antibiotic-associated diarrhea(AAD)is a condition characterized by diarrhea that occurs following the use of antibiotics and cannot be attributed to other causes.There are numerous types of antibiotics administered to elderly patients with severe illnesses,leading to a significant increase in the risk of AAD.However,there are limited reports analyzing the factors associated with AAD in elderly patients with severe illnesses.Objective To analyze the factors associated with antibiotic-related diarrhea in elderly ICU patients with severe illness who have received antibiotics.Methods Clinical data about patients admitted to the Department of Intensive Care Medicine at the First Medical Center of Chinese PLA General Hospital from January 1,2020 to June 30,2022 were retrospectively analyzed to identify the factors associated with antibiotic-associated diarrhea in elderly patients with severe illness.Results Of the 815 patients,there were 125 patients with AAD and 690 patients without AAD.Compared to the non-diarrhea group,the age-adjusted Charlson Comorbidity Index(aCCI)and SOFA scores were higher in the diarrhea group.Additionally,the usage rates of third-generation cephalosporin antibiotics,fluoroquinolones,carbapenems,glycopeptides,piperacillin-tazobactam sodium,and antifungal drugs were higher(P<0.05).The AAD group had a higher mortality rate than the non-AAD group(P<0.05).Multivariate Logistic regression analysis suggested that tracheotomy(OR=7.227,95%CI:2.147-24.326,P=0.001),CRRT(OR=4.529,95%CI:1.344-15.258,P=0.015),high C-reactive protein(OR=1.125,95%CI:1.019-1.241,P=0.019),high lipase(OR=1.005,95%CI:1.001-1.005,P=0.015),high aCCI(OR=1.706,95%CI:1.373-2.121,P<0.001),piperacillin tazobactam(OR=4.040,95%CI:1.405-11.622,P=0.010),third-generation cephalosporins(OR=6.787,95%CI:2.791-16.506,P<0.001),carbapenems(OR=5.714,95%CI:1.874-17.425,P=0.002),and diuretics(OR=9.098,95%CI:5.131-16.131,P<0.001)in critically ill elderly patients were associated with a higher risk of developing AAD.Conclusion Tracheotomy,continuous renal replacement therapy(CRRT),C-reactive protein,lipase,aCCI,piperacillin tazobactam sodium,third-generation cephalosporin antibiotics,carbapenems antibiotics,and diuretic use are independently associated factors for the occurrence of AAD in elderly patients with severe disease.Attention should be paid to these patients to prevent AAD.