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目的:研究老年住院患者抗菌药物相关性腹泻(AAD)的有关因素。方法:采用前瞻性研究。2007年1月至2008年6月因肺部、胆道和泌尿系感染住院的163例老年患者纳入该研究。患者中男132例,女31例,年龄65~103岁,平均(82±7)岁。均按药品说明书规定剂量静脉滴注给予抗菌药物,不同患者应用同一种药物给予相同剂量,疗程各不相同。分析患者年龄、住院时间、医疗干预(鼻饲、有创机械通气、留置导尿管等)、药物种类和疗程等因素与AAD的关系。结果:163例患者中48例发生AAD,发生率29.4%。腹泻出现在用药后2~26 d,19例腹泻<5次/d,29例≥5次/d。腹泻以不成形稀便及水样便为主,偶有黏液便及脓血便,伴有腹痛、腹胀。年龄<80岁和≥80岁患者AAD发生率分别为25.5%(13/51)和31.3%(35/112),差异无统计学意义(P>0.05)。住院时间<30 d和≥30 d患者AAD发生率分别为17.8%(19/107)和51.8%(29/56),差异有统计学意义(P<0.001)。给予医疗干预和无医疗干预患者AAD发生率分别为78.9%(15/19)和22.9%(33/144),差异有统计学意义(P<0.001)。应用1、2和≥3种抗菌药物的患者AAD发生率分别为13.3%(11/83)、29.4%(15/51)和75.9%(22/29),两两比较差异均有统计学意义(P<0.05,P<0.01)。AAD发生率较高的抗菌药为头孢哌酮-舒巴坦(42.9%)、克林霉素(40.0%)、阿莫西林-克拉维酸钾与哌拉西林-三唑巴坦(35.7%)。疗程<7 d、7~15 d和>15 d的患者AAD发生率分别为14.3%(4/28)、20.8%(15/72)和46.0%(29/63),疗程>15 d患者明显高于<7 d和7~15 d患者(P<0.01)。logistic多因素回归分析提示联合抗菌药物种类及医疗干预是导致腹泻的危险因素。结论:老年患者易发生抗菌药物相关腹泻,其有关因素为抗菌药物品种、多药联用、长期用药及医疗干预。老年患者使用抗菌药物应严密监测AAD的发生。
Objective: To study the related factors of antibiotic-associated diarrhea (AAD) in elderly inpatients. Methods: A prospective study was conducted. From January 2007 to June 2008, 163 elderly patients hospitalized for pulmonary, biliary and urinary tract infections were included in the study. There were 132 males and 31 females with a mean age of (82 ± 7) years, ranging in age from 65 to 103 years. All drugs were given by intravenous infusion of antibiotics prescribed in the instruction manual of the drug, and different patients were given the same dose of the same drug with the same course of treatment. Analysis of patient age, hospital stay, medical interventions (nasal feeding, invasive mechanical ventilation, indwelling catheter, etc.), drug types and duration of treatment and other factors and the relationship between AAD. Results: AAD occurred in 48 of 163 patients, with a rate of 29.4%. Diarrhea occurred 2 to 26 days after treatment, 19 cases of diarrhea <5 times / d, 29 cases ≥ 5 times / d. Diarrhea with loose stools and water samples will be the main occasional mucus and pus and blood will be accompanied by abdominal pain, abdominal distension. The incidence of AAD was 25.5% (13/51) and 31.3% (35/112) in patients aged <80 years and ≥80 years, respectively, with no significant difference (P> 0.05). The incidence of AAD was 17.8% (19/107) and 51.8% (29/56) in patients who were hospitalized for less than 30 days and more than 30 days, respectively. The difference was statistically significant (P <0.001). The incidence of AAD was 78.9% (15/19) and 22.9% (33/144) respectively in patients receiving medical treatment and without medical intervention, the difference was statistically significant (P <0.001). The incidence of AAD was 13.3% (11/83), 29.4% (15/51) and 75.9% (22/29) in patients with 1, 2 and 3 antibacterials, respectively, with statistically significant differences (P <0.05, P <0.01). Antibacterial agents with a higher incidence of AAD were cefoperazone-sulbactam (42.9%), clindamycin (40.0%), amoxicillin-clavulanate potassium and piperacillin-tazobactam (35.7% ). The incidence of AAD was 14.3% (4/28), 20.8% (15/72) and 46.0% (29/63) in patients on the 7th, 7th to 15th day and> 15th day, respectively Higher than <7 d and 7-15 d patients (P <0.01). Logistic multivariate regression analysis suggested that the combination of antimicrobial agents and medical interventions were risk factors for diarrhea. Conclusion: Antibiotic-related diarrhea is easy to occur in elderly patients. The related factors are antibacterial drug variety, multi-drug combination, long-term medication and medical intervention. The use of antimicrobial drugs in elderly patients should be closely monitored the occurrence of AAD.