住院患者抗菌药物相关性腹泻危险因素分析

目的观察住院患者抗菌药相关性腹泻(AAD)的发生情况,探讨AAD发病的相关危险因素.方法选取在住院治疗期间发生腹泻的患者285例,根据患者病史和粪便检查结果,将入选患者分为AAD组(188例)、非AAD组(97例).采用回顾性分析法,比较两组患者的基本情况、接受其他治疗干预措施情况、抗菌药物使用情况,并分析AAD发病的相关危险因素.结果 AAD组年龄≥60岁、监护室病例、住院时间≥21 d的患者比例明显高于非AAD组,差异具有统计学意义(P0.05);AAD组患者使用抗菌药时间14 d、用抗菌药物数量≥2种的比例均明显多于非AAD组,差异具有统计学意义(P0.05);AAD组患者使用率前五的抗菌药物为:头孢类抗菌药164例(87.23%)、酶抑制剂复合物144例(76.59%)、碳青霉烯类102例(54.26%)、喹诺酮类85例(45.21%)、林可霉素类76例(40.43%);两组患者的治愈率、好转率、死亡率之间差异均无统计学意义(P0.05).年龄≥60岁、抗菌药使用时间14 d、抗菌药使用种类≥2种、接受禁食、侵袭性操作等治疗干预措施是住院患者并发AAD的独立危险因素.结论年龄≥60岁的老年患者、长时间联合使用抗菌药、住院期间禁食和接受侵袭性操作的患者易发生AAD,临床治疗中对于上述患者应注意抗菌药物的使用.

Analysis on Risk Factors of Antibiotic-Associated Diarrhea in Hospitalized Patients

Objective To observe the occurrence of antibiotic-associated diarrhea ( AAD ) in hospitalized patients,and to explore the related risk factor for the onset of AAD. Method According to the patients’ history and stool examination results,285 patients with diarrhea during the treatment were enrolled, and divided into AAD group (188 cases) ,non AAD group (97 cases) . Using retrospective analysis method,the basic conditions, other treatment interventions and the usage of antibacterial drugs were compared in patients of two groups,and the related risk factors of AAD are analyzed. Results When the ICU patients of the ADD group were 60 years old or elder with more than 21 d hospitalization time,the occurrence rate of the disease was significantly higher than the non ADD group ( P<0 . 05 ) . The number of patients in AAD group who used more than 2 kinds of antibacterial drug lasting for 14 days or more was seriously larger than the non ADD group ( P<0 . 05 ) . The top 5 usage of antimicrobial agents were as follows:cephalosporin antibacterial drugs in 164 cases (87. 23%),enzyme inhibitor complex in 144 cases (76. 59%),carbapenems in 102 cases (54. 26%),85 cases (45. 21%) of quinolones, Lin Kemei prime in 76 cases (40. 43%). The cure rate,improvement rate and mortality rate between the two groups showed no statistically significant differences ( P>0 . 05 ) . The independent risk factors suggested to be elder age (≥60 ) , use of antibiotics (≥2 species ) , antibiotic use time>14 d, accept of fasting, invasive intervention treatment. Conclusions Elderly patients aged more than 60,long time using antibacterial drugs, fasting during hospitalization and receiving invasive operation were prone to suffer from AAD. In these cases,more attention should be paid for the use of antibacterial drugs in clinical treatment.