成人细菌性重症肺炎并发抗生素相关性腹泻的影响因素分析

Impact of antibiotic associated diarrhea in adults with bacterial severe pneumonia

[目的]探讨成人细菌性重症肺炎并发抗生素相关性腹泻(antibiotic associated diarrhea, AAD)的影响因素,给临床抗生素应用提供借鉴意义。[方法]入选成人细菌性重症肺炎患者486例,依据患者是否发生AAD分成观察组184例、对照组302例。采集患者的一般资料及临床资料,先采用单因素分析成人细菌性重症肺炎并发AAD可能的影响因素,再利用多因素Logistic回归分析独立危险因素。[结果]486例细菌性重症肺炎患者,共并发184例AAD,发生率为37.68%。单因素分析显示,观察组与对照组在性别、头孢类、青霉素、万古霉素等方面,差异无统计学意义(P>0.05);观察组患者与对照组相比在年龄、大环内酯类、碳青霉烯类、使用抗生素种类、抗生素使用时间及侵袭性操作上相比,差异有统计学意义(P<0.05)。将上述具有差异的单因素纳入多因素Logistic回归分析进一步研究显示,年龄、大环内酯类、碳青霉烯类、使用抗生素种类、抗生素使用时间及侵袭性操作是并发AAD的独立危险因素(P<0.05)。[结论]成人细菌性重症肺炎并发AAD危险因素较多,包括年龄、大环内酯类、碳青霉烯类、使用抗生素种类、抗生素使用时间及侵袭性操作等,临床上应重点关注并采取针对性预防措施。

[Objective]To explore the influencing factors of bacterial severe pneumonia complicated by antibiotic associated diarrhea(AAD)in adults, so as to draw on the clinical application of antibiotics.[Methods]The totals of 486 adult patients with severe bacterial pneumonia admitted were selected and divided into observation group 184(who developed AAD)and control group 302(who did not develop AAD)according to whether the patients developed.The general data and clinical data of the patients were collected, and the possible influencing factors of adult bacterial severe pneumonia complicated by AAD were firstly analyzed by univariate analysis, and the independent risk factors were further analyzed by multivariate logistic regression analysis.[Results]The totals of 486 patients with severe bacterial pneumonia, complicated by a total of 184 AAD,occurred in 37.68%.Univariate analysis showed that there were no significant differences between the observation group and the control group with respect to gender, cephalosporins, penicillin, and vancomycin(P> 0.05).Patients in the observation group had statistically significant differences(P<0.05)in age, macrocyclic lipids, carbapenems, kind of antibiotics used, duration of antibiotic use, and invasive procedures compared with the control group.The above univariate variables with differences were further investigated by multivariate logistic regression analysis, which showed that age, macrocyclic lipids, carbapenems, type of antibiotics used, duration of antibiotic use and invasive maneuvers were independent risk factors for concurrent AAD(P<0.05).[Conclusion]Bacterial severe pneumonia in adults is complicated by many risk factors for AAD,including age, macrocyclic lipids, carbapenems, the type of antibiotic used, the duration of antibiotic use and invasive maneuvers, which should be focused on and targeted prevention measures.