危重症患者抗菌素相关性腹泻的临床分析

目的　分析危重症患者抗菌素相关性腹泻的危险因素 ,进一步探讨抗菌素应用对腹泻严重程度的影响。　方法　对我院内科 2年内 5 5例抗菌素相关性腹泻的危重症患者的临床资料进行回顾性分析。　结果　抗菌素的不合理应用是影响抗菌素相关性腹泻发生、严重程度及预后的最重要因素。　结论　对于危重症患者应避免由低级到高级频繁更换抗菌素。     

危重患者与抗生素相关性腹泻

目的 探讨高危患者抗生素相关性腹泻的预防，加强医护人员合理应用抗菌药物的管理。方法 采用前瞻性和回顾性相结合的调查方法，分析导致抗生素相关性腹泻的因素和控制措施。结果 抗菌药物使用种类多样化、更换频繁、年龄、原发病的严重程度、侵袭性操作是主要的诱发因素。结论 提高医护人员对抗菌药物可造成体内微生态失调的重视，合理应用抗菌药物，避免不同种类抗菌药物频繁更换，可降低危重患者抗生素相关性腹泻的发生。     

危重症患者抗生素相关性腹泻的调查

目的 探讨危重症患者抗生素相关性腹泻（AAD）的发病特点及危险因素。方法 用多因素非争件logistic分析方法对2002年1月2004年12月我院危重病监护室46例AAD患者进行回顾性调查及分析。结果 重症监护室医院感染率10.09％，其中医院获得性消化道感染占27.33％，AAD占消化道感染的58.22％。第3代头孢菌素、克林霉素较易发生AAD，住院天数、禁食、气管插管、泌尿道插管、手术、抗生素使用时间、联合使用抗茵药物是AAD的危险因素。结论 合理使用抗生素。尽量避免各种医疗干预措施。缩短住院时间，可以降低危重症患者AAD的发生率。     

238例老年内科住院患者抗生素相关性腹泻分析

目的 探讨老年内科住院患者抗生素相关性腹泻发生情况和相关因素,为提高临床合理用药,减少或避免不良反应提供参考.方法 对238例使用抗生素的住院患者发生相关性腹泻的临床资料进行回顾性分析.结果 抗生素相关性腹泻的发生与其种类、抗生素联用、用药时间、患者年龄、基础疾病等因素有关.结论 老年患者易发生抗生素相关性菌群失调,合理使用抗生素,减少老年患者的易患因素,可降低老年患者抗生素相关性腹泻的发生率和严重程度.     

新生儿抗生素相关性腹泻的临床研究

目的 探讨新生儿抗生素相关性腹泻的发病率、发病因素及微生态疗法的临床作用。方法 对山西省儿童医院新生儿内科2002年1月1日～3月31日住院患者进行了抗生素使用、抗生素相关性腹泻的发生率及发病因素和其他相关临床资料的调查，并将其作为对照组，2002年4月住院并具完整病历的出院患者作为服药组，观察微生态制剂贝飞达(双歧三联活菌制剂)对抗生素相关性腹泻的预防作用。结果 抗生素相关性腹泻的发生率达24．54％，不合理使用抗生素是导致这一结果的主要原因，微生态制剂对防止抗生素相关性腹泻有一定作用。结论 减少广谱抗生素的使用、减少联合用药和避免住院时间过长、辅之以微生态制剂，可有效减少抗生素相关性腹泻的发生，后者还可通过免疫调节功能而促进原发疾病临床康复，从而有利于减少住院时间和住院费用。     

危重症患者抗生素相关性腹泻的临床特点及危险因素分析

抗生素相关性腹泻(AAD)是抗感染药物的一种常见不良反应,是由于应用抗生素造成肠道菌群紊乱而引起的呕吐、腹泻等消化道症状[1].危重症患者由于免疫功能极度低下、侵袭性操作较多、病原学检查的滞后性,以及抗生素的盲目应用,其AAD发生率较高.AAD的发生延长了患者的住院时间、加重了精神负担,故了解AAD的临床特点和相关因素,对有效预防和控制AAD的发生以及指导抗生素的应用具有重要意义.本研究对发生AAD的46例危重症病例进行回顾性分析,探讨其临床特点以及相关危险因素,报道如下.     

78例脑血管意外患者发生抗生素相关性肠炎的临床分析

目的探讨脑血管意外患者发生抗生素相关性肠炎的临床特点和治疗体会。方法对78急性脑血管意外并发抗生素相关性肠炎患者的临床资料进行回顾性分析。结果所有患者均有典型的腹泻症状,便隐血检查阳性率较高,经过对症治疗病情均得到有效控制。结论抗生素相关性肠炎因素较为复杂,应通过规范用药降低发病率,在发病后根据具体病情采取对症治疗,使病情的严重程度得到有效降低。     

78例脑血管意外患者发生抗生素相关性肠炎的临床分析

目的探讨脑血管意外患者发生抗生素相关性肠炎的临床特点和治疗体会。方法对78急性脑血管意外并发抗生素相关性肠炎患者的临床资料进行回顾性分析。结果所有患者均有典型的腹泻症状,便隐血检查阳性率较高,经过对症治疗病情均得到有效控制。结论抗生素相关性肠炎因素较为复杂,应通过规范用药降低发病率,在发病后根据具体病情采取对症治疗,使病情的严重程度得到有效降低。     

益生菌预防神经重症监护病房老年患者抗生素相关性腹泻的疗效观察

目的通过预防性加用益生菌,探讨在神经重症监护病房使用抗生素的老年患者中对抗生素相关性腹泻的防治效果。方法收集80例神经重症监护病房系统抗生素治疗患者,随机分为对照组40例、实验组40例,实验组在使用抗生素同时给予益生菌,两组出现腹泻后均给予蒙脱石散剂止泻。比较两组抗生素相关性腹泻发病率、持续时间及严重程度。结果实验组腹泻发生率低于对照组,差异有统计学意义(P0.05),实验组腹泻持续时间短于对照组,差异有统计学意义(P0.05),实验组发生极重度腹泻的例数显著少于对照组。结论益生菌可显著降低神经重症监护病房老年患者抗生素相关性腹泻的发生,且缩短腹泻持续时间,显著降低腹泻严重程度。     

危重症妊娠相关性肾损伤的临床特征分析

目的分析危重症妊娠相关性肾损伤的临床特征,包括病因、临床特点及预后。方法回顾性分析102例危重症产妇的临床资料,均发生妊娠相关性肾损伤;分析危重症妊娠相关性肾损伤的病因、危险因素及不同病期患者的预后。结果本组102例危重症妊娠相关性肾损伤产妇的病因依次为子痫前期、失血性休克、HELLP综合征、急性脂肪肝;高血压、失血性休克、尿蛋白、低血小板均作为危重症妊娠相关性肾损伤的独立危险因素,差异有统计学意义(P0.05);随着急性肾损伤严重程度加重,肾替代治疗率随之提高,ICU治疗时间随之延长,肾功能完全恢复的可能性越低。结论危重症妊娠相关性肾损伤产妇的病因及危险因素较多,预后与病情严重密切相关,对于危重症产妇的治疗,应加强生化指标的监测,警惕妊娠相关性急性肾损伤发生,及早给予有效治疗,对于恢复肾功能具有积极作用。     

抗生素相关性腹泻临床研究

目的了解医院感染抗生素相关性腹泻临床特点,提出预防控制措施. 方法回顾分析1996年1月～2002年12月儿科住院病历7 314份,获得医院感染抗生素相关性腹泻102例,与医院感染非抗生素相关性腹泻26例作对照分析. 结果医院感染抗生素相关性腹泻较非抗生素相关性腹泻发病率高、临床症状重;抗生素使用时间≥5 d,腹泻感染率明显升高,联合使用抗生素种类越多,腹泻感染率越高. 结论合理使用抗生素,严格控制广谱抗生素的使用,是预防控制医院感染抗生素相关性腹泻的关键措施.     

Underlying disease severity as a major risk factor for nosocomial Clostridium difficile diarrhea.

OBJECTIVE: To determine the diagnostic accuracy of an index of underlying disease severity (Horn's index) in identifying patients with a high probability of having nosocomial Clostridium difficile diarrhea as a complication of antimicrobial therapy. DESIGN: A prospective cohort study of 252 adult patients admitted to the hospital and receiving antibiotics. Risk facctors for C. difficile diarrhea were first determined retrospectively in a different cohort of 300 hospitalized patients (primary cohort) and then prospectively in this cohort of 252 hospitalized patients receiving antibiotics (secondary cohort). At the time of hospital admission, disease was rated by clinicians as mild (1), moderate (2), severe (3), or extremely severe (4) using a modified Horn's index. Multivariable logistic regression analysis was used to determine the odds ratio (OR) for C. difficile diarrhea associated with increasing levels of disease severity. SETTING: An urban teaching hospital affiliated with a medical school in Boston, Massachusetts. RESULTS: The incidence of nosocomial C. difficile diarrhea was 8.7% in the primary cohort and 11% in the secondary cohort In the prospective cohort study (secondary cohort), the OR for C. difficile diarrhea associated with extremely severe disease was 17.6 (95% confidence interval, 5.8 to 53.5). The sensitivity, specificity, and positive and negative predictive values of a Horn's index score of 3 or more (severe to extremely severe disease) as a predictor of nosocomial C. difficile diarrhea were 79%, 73%, 27%, and 96%, respectively. CONCLUSIONS: These findings provide a means of early stratification of hospitalized patients receiving antibiotics according to their risk for nosocomial C. difficile diarrhea. Patients with severe to extremely severe disease at the time of admission may benefit from careful monitoring of antibiotic prescribing and early attention to infection control issues. In the future, these "high-risk" patients may benefit from prophylaxis studies of novel agents being developed to prevent C. difficile diarrhea.     

Longitudinal studies of infectious diseases and physical growth of children in rural Bangladesh. II. Incidence of diarrhea and association with known pathogens

Longitudinal studies were done in two villages rural Bangladesh to learn more about the interactions between infectious diseases and the nutritional status of children. Diarrheal diseases, identified by surveillance of 197 children aged 2-60 months, were studied for bacterial, viral and parasitic enteropathogens in 1978-1979. The annual incidence of diarrhea was highest in children aged 2-11 months, and declined progressively with age from seven to four episodes per child per year. An enteropathogen was identified from rectal cultures taken during diarrhea in 51% of episodes and from 6% of monthly cultures taken when diarrhea was not present. Enterotoxigenic Escherichia coli were the pathogens found most frequently, followed by shigellae and rotaviruses. Diarrheal episodes associated with shigellae had the longest duration, while episodes associated with Vibrio cholerae or with rotavirus were more frequently associated with dehydration. E. coli diarrhea had a peak incidence during the hot months, and shigellosis was more frequent during the cool, dry months.     

成都市居民腹泻病流行特征及就医现状调查

目的了解成都市腹泻病流行现状及就诊趋势,为腹泻病管理和防控措施的制定提供基础数据。方法按照多阶段随机抽样的方法选择成都市成华区和大邑县29 355名居民为调查对象,采用问卷调查的方式对其腹泻发病和就医现状进行调查。结果腹泻的2周发病率为3.8%。10岁组的腹泻发病率在各年龄段中最高,为7.4%,学生的腹泻发病率在各职业中最高,为5.9%,各年龄段间和职业间腹泻发病率差异均有统计学意义。被调查的腹泻患者中仅有28.4%选择到医院就诊或住院治疗,34.7%的被调查者腹泻后不做任何治疗,36.9%的被调查者腹泻后自行买药治疗。结论成都市居民腹泻发病率较高,尤其是低年龄段学生的腹泻发病最多,需要进一步加强居民,尤其是重点人群的健康教育和行为干预等工作。     

Serum sickness in children after antibiotic exposure: estimates of occurrence and morbidity in a health maintenance organization population

The computerized outpatient records of the Harvard Community Health Plan, a 230,000-member health maintenance organization, were used to determine the frequency with which serum sickness is recognized in the practice setting after exposure to antibiotics. The medical records of 3,487 children who had been prescribed cefaclor or amoxicillin were searched in December 1986 for coded diagnoses of serum sickness and related conditions. Diagnoses were validated by blinded review of dictated and written office notes. There were 12 cases of serum sickness in 11,523 child-years. During this time, these children were prescribed 13,487 courses of amoxicillin, 5,597 courses of trimethoprim-sulfamethoxazole (TMP-SMZ), 3,553 courses of cefaclor, and 2,325 courses of penicillin V. Serum sickness was considered to be antibiotic-related if it occurred within 20 days of initiation of antibiotic therapy. Five cases were temporally associated with cefaclor, one with both amoxicillin and TMP-SMZ, four with TMP-SMZ alone, and one with penicillin V alone. One case was not associated with any antibiotic exposure. All antibiotic-related cases occurred in children under age 6 years who were treated for otitis media or streptococcal pharyngitis, and most cases began 7-11 days after initiation of antibiotic. All but one of the antibiotic-related cases occurred in children who had relatively heavy lifetime antibiotic exposure. The risk of serum sickness was significantly elevated after cefaclor compared with amoxicillin, even among the most heavily exposed children (relative risk = 14.8, p = 0.01, 95% confidence interval 2.0-352.0). Most cases prompted several physician visits, but none required hospitalization.     

Hospital-acquired diarrhea in adults: a prospective case-controlled study in Mexico

OBJECTIVE: To know the incidence, etiology, risk factors, morbidity, and mortality of nosocomial diarrhea in adults. DESIGN: Nested case-control study, matched by service, length of stay, date of admission, and presence of leukopenia and/or the acquired immunodeficiency syndrome (AIDS). Cases were those who developed nosocomial diarrhea. Controls were those who did not develop nosocomial diarrhea during a comparative period nor during the next ten days. Stool samples were processed in search for parasites, yeasts, bacteria, and rotavirus. SETTING: Third-level referral center, in Mexico City, Mexico, for general internal medicine and surgical problems. PATIENTS: Eligible subjects were all new admissions to the hospital from November 1987 to September 1988. Reasons for exclusion were presence of chronic diarrheal disease or melena. There were 115 cases and 111 controls. RESULTS: Overall risk of acquiring nosocomial diarrhea was 5.5%, or 1.8 episodes per 100 patient-weeks. A potential pathogen was found in 59%. Yeasts and Entamoeba histolytica were the most frequently isolated pathogens. Mortality in cases was 18%, as compared with 5% in controls (p less than .01). Multivariate analysis showed enteral feeding, recent enemas, presence of Candida species, use of antacids/H2-blockers, and presence of nasogastric tubes as significant risk factors for nosocomial diarrhea. CONCLUSIONS: Diarrhea is a common complication in hospitalized patients. It occurs more often than previously suspected and is linked with a substantial mortality. The spectrum of etiologic agents is different from that reported in pediatric hospitals. Given that nosocomial diarrhea may constitute, at least, a marker of severity of illness, it should receive more attention in general hospitals.     

Probiotics reduce symptoms of antibiotic use in a hospital setting: A randomized dose response study

Probiotics are known to reduce antibiotic associated diarrhea (AAD) and Clostridium difficile associated diarrhea (CDAD) risk in a strain-specific manner. The aim of this study was to determine the dose-response effect of a four strain probiotic combination (HOWARU^® Restore) on the incidence of AAD and CDAD and severity of gastrointestinal symptoms in adult in-patients requiring antibiotic therapy. Patients (n = 503) were randomized among three study groups: HOWARU^® Restore probiotic 1.70 × 10¹⁰ CFU (high-dose, n = 168), HOWARU^® Restore probiotic 4.17 × 10⁹ CFU (low-dose, n = 168), or placebo (n = 167). Subjects were stratified by gender, age, and duration of antibiotic treatment. Study products were administered daily up to 7 days after the final antibiotic dose. The primary endpoint of the study was the incidence of AAD. Secondary endpoints included incidence of CDAD, diarrhea duration, stools per day, bloody stools, fever, abdominal cramping, and bloating. A significant dose-response effect on AAD was observed with incidences of 12.5, 19.6, and 24.6% with high-dose, low-dose, and placebo, respectively (p = 0.02). CDAD was the same in both probiotic groups (1.8%) but different from the placebo group (4.8%; p = 0.04). Incidences of fever, abdominal pain, and bloating were lower with increasing probiotic dose. The number of daily liquid stools and average duration of diarrhea decreased with higher probiotic dosage. The tested four strain probiotic combination appears to lower the risk of AAD, CDAD, and gastrointestinal symptoms in a dose-dependent manner in adult in-patients.     

微生态制剂对抗生素相关性腹泻预防作用的研究

目的 探讨微生态制剂培菲康、整肠生对抗生素相关性腹泻（AAD）的预防作用。方法 调查患有严重肺和（或）腹腔感染，静脉应用〉2种抗菌药物连续治疗〉5d，排除慢性胃肠道疾病的出院成年患者344例作为对照组；按≤59岁及≥60岁分为两组，了解AAD发生情况；再选择符合上述条件的住院患者141例，随机分为两组，在抗感染治疗的同时，分别加用双歧杆菌／嗜酸乳杆菌／粪肠球菌制剂（培菲康）或地衣芽胞杆菌胶囊制剂（整肠生），比较分析各组≤59岁及≥60岁患者AAD的发生情况。结果 对照组≥60岁患者AAD发生率（22．31％）明显高于≤59岁患者（8．88％P〈0．01）；在抗菌治疗同时口服培菲康或整肠生两组≥60岁患者AAD发生率均明显低于对照组。结论 应用抗菌药物治疗同时，口服微生态制剂培菲康或整肠生均能有效预防AAD的发生。     

Cost-effectiveness and user characteristics of clinic based services for the treatment of diarrhea: a case study in Bangladesh

This study compares the cost-effectiveness of three services for the treatment of diarrhea, in a rural area of Bangladesh. It also examines patterns of user composition, and how these depend on factors other than disease severity and incidence. The three services are a large hospital-style treatment center, an ambulance system bringing patients from greater distances, and a small treatment center staffed by paramedics. The results show that the long run average cost per patient is about +16 at the large center, with an additional +13 if the patient came by ambulance, compared to +3 at the small center. Corresponding costs per death averted were +1300, an additional +360, and +190 respectively. Previous studies have suggested that there is no more cost-effective alternative for the prevention of diarrhea, although in future home-based oral rehydration therapy may be a potential alternative. Each service exhibits use patterns suggesting that males and especially small boys receive preferential access to treatment. This bias is exacerbated as distance from the center increases, or if a fee is charged. The study concludes firstly that diarrhea treatment costs in clinics are relatively high, and secondly that unintended biases in service use should be an important consideration in service design.     

广州市566株腹泻病例沙门菌的血清型分布及耐药性分析

目的 了解广州市近两年腹泻病例沙门菌分离株的血清型分布及耐药情况。方法 对广州市8家腹泻病监测医院2012年、2013年间上送的566株沙门菌进行血清分型,同时采用纸片扩散法(K- B法)对12种抗菌药物进行敏感性分析。结果 566株沙门菌分为62个血清型,前三位分别为鼠伤寒沙门菌41.52%（235/566）、肠炎沙门菌15.72%（89/566）和斯坦利沙门菌7.95%（45/566）。药敏分析显示菌株对头孢类抗菌药物敏感率达85%以上,对环丙沙星的敏感性也较高,为75.44%,而对氨苄西林、磺胺复合物、四环素、萘啶酸的耐药率达60%。耐3种及以上抗生素的菌株占71.02%（402/566）,出现ACSSuT+耐药谱（对氨苄西林、氯霉素、链霉素、磺胺复合物、四环素等5种或更多药物多重耐药）的总耐药率为27.39%（155/566）。鼠伤寒沙门菌ACSSuT+耐药率达44.68%（105/235）。结论 本地区沙门菌临床分离株以鼠伤寒沙门菌和肠炎沙门菌为主,菌株对头孢类抗菌药物的敏感性较高,但某些血清型菌株存在严重的多重耐药现象,其中鼠伤寒沙门菌是耐药最严重的血清型,应引起重视。