益生菌预防成人抗生素相关性腹泻的荟萃分析

目的:探讨益生菌的使用与成人抗生素相关性腹泻(AAD)的关联,分析益生菌预防AAD的有效性及安全性.方法:系统检索PubMed,Embase,CINAHL,AMED,the Cochrane database of SystematicReviews,the Cochrane Controlled TrialsRegister和中国期刊全文数据库(CNKI),检索时间跨度从1966-01/2012-04.我们只纳入随机对照试验,研究对象>18周岁,研究内容为服用抗生素的同时服用益生菌预防AAD.结果:本研究结果表明,RR=0.45,95%CI:0.29-0.69,P<0.001,益生菌可以显著降低服用抗生素后发生腹泻的机率.基于益生菌种类的亚组分析的结果(RR=0.42,95%CI:0.20-0.85,P=0.003)同样证明了益生菌预防AAD的有效性.结论:益生菌可以显著降低服用抗生素后发生成人AAD的机率.     

益生菌在防治老年人抗生素相关性腹泻中的应用与思考

益生菌是一类能使其宿主获益的活体微生物,应用广泛,但目前并没有大数据支持其临床应用。很多临床研究证实了不同益生菌防治抗生素相关性腹泻（AAD）的有效性,但基于近年的数据,回答益生菌是否可降低老年人AAD发生率的科学依据尚显薄弱。总的来说,益生菌有着非常好的安全记录,特定人群包括AAD患者使用益生菌将会获益,但需要个体化。     

老年人抗生素相关性腹泻

抗生素相关性腹泻(antibiotic associated diarrhea，AAD)是指应用抗生素后发生的、与该抗生素有关的腹泻，也称抗生素相关性结肠炎，是抗生素的一种常见不良反应。老年病人由于存在诸多特殊因素，是AAD的高发、高危人群，因此，正确认识、治疗和预防AAD对老年病人尤为重要。     

益生菌制剂预防老年患者抗生素相关性腹泻

背景: 抗生素相关性腹泻(AAD)是临床应用抗生素的常见并发症。目前益生菌制剂用于AAD的治疗已得到广泛认可,但其是否可用于预防AAD仍存在争议。目的: 研究成年和老年住院患者的AAD发生率,以及益生菌制剂对老年患者AAD的预防作用。方法: 根据入选标准连续纳入同期接受抗生素治疗的成年和老年住院患者,后者随机分为两组,分别予地衣芽孢杆菌1.5×10~9 cfu/d干预至停用抗生素后1周或不予干预。分析各组抗生素使用情况和AAD发生率。结果: 成年组与老年未干预组间、老年干预组与未干预组间抗生素使用情况均无明显差异。成年组AAD发生率明显低于老年未干预组(10.6%对27.4%,P=0.001),老年干预组亦明显低于老年未干预组(13.6%对27.4%,P=0.01),差异均有统计学意义。结论: 老年患者为AAD高发人群,益生菌制剂与抗生素同时应用可有效减低老年住院患者的AAD发生率,可作为AAD预防措施应用于临床。     

抗生素相关性腹泻

抗生素相关性腹泻（antibiotic-associated diarrhea,AAD）是指应用抗生素后发生的、与抗生素有关的腹泻。700多种可引起腹泻的药物中25％为抗生素。AAD的发病率因人群及抗生素种类的差异而不同。最常见的致病菌是艰难梭菌。按AAD的病情程度不同,可将其分为5种类型。本文对AAD的发病机制、临床表现及诊治作一综述。     

嗜酸乳杆菌对住院老年患者抗生素相关性腹泻的预防作用研究

目的研究嗜酸乳杆菌对住院老年患者抗生素相关性腹泻（AAD）的预防作用。方法在华东医院老年病科病房接受抗生素治疗的感染性疾病患者235例,随机分为干预组118例（男107例,女11例）,平均年龄（83±8）岁和对照组117例（男108例,女9例）,平均年龄（84±7）岁。干预组患者同时口服或鼻饲嗜酸乳杆菌胶囊700mg,每天2次,直到停用抗生素后第7天;对照组不采取任何干预措施。比较两组AAD释患率及临床类型的差异。结果干预组118例,发生AAD5例,罹患率4．2％;临床分型均为单纯腹泻型。对照组117例,发生AAD28例,罹患率23．9％;临床分犁包括单纯腹泻型、结肠炎型和假膜结肠炎型。两组罹患率比较差异有统计学意义（P〈0．01）。结论老年住院患者是AAD的高发、高危人群。嗜酸乳杆菌胶囊对住院老年患者抗生素相关性腹泻有一定的预防作用。     

婴幼儿抗生素相关性腹泻的临床分析

[目的]探讨如何减少婴幼儿抗生素相关性腹泻(AAD)的发生。[方法]通过对使用抗生素治疗后发生婴幼儿AAD的患儿治疗情况进行比较分析。[结果]婴幼儿抗生素相关性腹泻发生与年龄、抗生素的种类及联合用药、抗生素使用时间、禁食与否及是否采用干预措施等因素有关。[结论]避免抗生素滥用及不规范使用和早期干预可明显减少AAD的发生。     

老年患者抗生素相关性腹泻易感因素分析

由于抗生素的广泛应用,抗生素相关性腹泻(Antibiotic-associated diarrhea,AAD)日益增多,研究显示,老年是发生AAD的一个主要危险因素.合理的选择抗生素可以减少内源性梭状芽孢杆菌的筛选几率,有效的避免AAD[1].为了解老年患者抗生素相关性腹泻的易感因素,本文对老年患者发生抗生素相关性腹泻的情况进行调查分析.     

重视抗生素相关性腹泻的预防和治疗

随着抗生素种类的不断增多以及在临床的广泛使用，不合理使用抗生素的情况日渐增多，抗生素相关性腹泻（antibiotic-associated diarrhea．AAD）日益受到关注。5%～30％的患者在抗生素治疗早期或治疗结束后2个月内会发生AAD。     

抗生素相关性腹泻死亡6例分析

采用回顾性调查的方法,对2006年医院感染病例中发生抗生素相关性腹泻（AAD）病例的临床资料进行分析。结果显示,住院病人发生AAD 42例,占医院感染病例的13.86%,死亡6例,死亡率达14.29%,占该年度医院感染死亡病例的15.79%。抗生素相关性腹泻,特别是伪膜性结肠炎,直接威胁病人的生命安全,已成为医院感染的突出问题;防治的关键是合理使用抗菌药,联合应用微生态制剂可起到防治作用。     

难辨梭状芽孢杆菌相关性腹泻研究进展

难辨梭状芽孢杆菌是一种革兰阳性肠道病原体。难辨梭状芽孢杆菌相关性腹泻（CDAD）及其引起的假膜性肠炎为消化道多发病。难辨梭状芽孢杆菌可产生毒素A和毒素B，侵入肠黏膜后引起细胞病变，导致一系列感染相关临床表现。免疫学机制在难辨梭状芽孢杆菌感染相关疾病的发病中起重要作用。本文就CDAD的发病机制、临床表现及其检测和治疗作一综述。     

The role of physical proximity in nosocomial diarrhea.

To examine physical proximity as a risk factor for the nosocomial acquisition of Clostridium difficile-associated diarrhea (CDAD) and of antibiotic-associated diarrhea (AAD), we assessed a retrospective cohort of 2859 patients admitted to a community hospital from 1 March 1987 through 31 August 1987. Of these patients, 68 had nosocomial CDAD and 54 had nosocomial AAD. In multivariate analysis, physical proximity to a patient with CDAD (relative risk [RR], 1.86; 95% confidence interval [CI], 1.06-3.28), exposure to clindamycin (RR, 4.22; 95% CI, 2.11-8.45), and the number of antibiotics taken (RR, 1.49; 95% CI, 1.23-1.81) were significant. For patients with nosocomial AAD, exposure to a roommate with AAD (RR, 3.94; 95% CI, 1. 27-12.24), a stay in an intensive care unit or cardiac care unit (RR, 1.93; 95% CI, 1.05-3.53), and the number of antibiotics taken (RR, 2.01; 95% CI, 1.67-2.40) were significant risk factors. Physical proximity may be an independent risk factor for acquisition of nosocomial CDAD and AAD.     

Comparison of rapid tests of toxin A and glutamate dehydrogenase and culture for detection of Clostridium diffcile]

Clostridium difficile is a major cause of antibiotics-associated diarrhea (AAD), and accounts for 15-20% of all the cases. Especially, AAD caused by C. difficile is called as C. difficile-associated diarrhea (CDAD). Diagnosis of CDAD is made by identification of C. difficile in the feces obtained from the patients with diarrhea after administration of antibiotics. We herein compared 3 methods, detection of toxin A and glutamate dehydrogenase (GDH) as well as culture for C. difficile. Two hundred and thirty-two samples obtained from 148 patients with CDAD were investigated. Fifty-five (23.7%), 56 (24.1%), and 93 (40.1%) of the 232 samples were positive for toxin A, GDH, and culture, respectively. Sensitivity, specificity, predictive value of positive result, and predictive value of negative result of method of detection of toxin A were estimated to 53%, 96%, 90%, 75% and those of GDH were 56%, 99%, 98%, 78%. These results indicated that we should carefully interpret the results obtained by these methods, especially in the cases that showed negative for C. difficile.     

Probiotics for prevention of antibiotic-associated diarrhea

Antibiotic-associated diarrhea (AAD) occurs in approximately 25% of patients receiving antibiotics. Hospitalized patients with AAD are at increased risk for nosocomial infections and have a higher mortality. Probiotics are living microorganisms used to restore gut health by changing the intestinal microbiota. Several have been studied for the prevention of AAD. Five meta-analyses of trials of probiotics for the prevention of AAD have been performed. The results showed an overall reduction in the risk of AAD when probiotics were coadministered with antibiotics. McFarland conducted the largest meta-analysis to date analyzing 25 randomized controlled trials of probiotics for the prevention of AAD including 2810 subjects. More than half of the trials demonstrated efficacy of the probiotic. In particular, Lactobacillus GG, Saccharomyces boulardii, and the probiotic mixtures were effective. The Cochrane Database of Systematic Reviews published a review of the literature on the use of probiotics for the prevention of pediatric AAD, including 10 randomized trials testing 1986 children. The per protocol pooled analysis, but not the intent-to-treat analysis, showed that probiotics are effective for preventing AAD with the number needed to treat to prevent 1 case of diarrhea being 10. Lactobacillus GG, Bacillus coagulans, and S. boulardii appeared to be most effective. Probiotics are generally safe, however, they should be used with caution in patients who have compromise of either the immune system or the integrity of the intestinal mucosa, and in the presence of a central venous catheter.     

难辨梭状芽孢杆菌相关性腹泻的中西医治疗进展

难辨梭状芽孢杆菌相关性腹泻(Clostridium difficile-associated diarrhea,CDAD)是由难辨梭状芽孢杆菌感染引起的腹泻,是抗生素相关性腹泻中的一个严重亚型.近年来,CDAD因其发病率及严重程度逐年增高,受到各国专家的普遍关注.目前在美国、加拿大和欧洲等国家CDAD的发病率和严重程度显著增加,甚至出现暴发流行.难辨梭状芽孢杆菌是一种革兰阳性肠道病原体,可产生毒素A和毒素B,侵入肠黏膜后引起细胞病变,导致一系列感染相关临床表现.其发病绝大多数与近期内接受广谱抗生素治疗有关,但高龄、慢性病史、长期住院等因素亦为该病发生的危险因素.一旦确诊或高度怀疑本病,应立即停用原有抗生素或换用其他不易导致CDAD的药物,同时应用甲硝唑或万古霉素治疗.近期相关研究表明,除甲硝唑、万古霉素外,还可应用替考拉宁、微生态制剂、单克隆抗体、复方中药制剂等治疗CDAD.本文就难辨梭状芽孢杆菌相关性腹泻的危险因素、治疗与预防方法等研究进展作一综述.     

枯草杆菌肠球菌二联活菌胶囊治疗抗菌药物相关性腹泻的临床观察

目的评价枯草杆菌肠球菌二联活菌胶囊对抗菌药物相关性腹泻（AAD）的疗效及安全性。方法以本院63例抗菌药物相关性腹泻患者作为研究对象,随机分为治疗组（33例）和对照组（30例）,治疗组给予营养支持治疗,同时加服枯草杆菌肠球菌二联活菌胶囊（美常安）2粒,3次／日,对照组仅给予营养支持治疗,治疗14天后观察两组患者的腹泻缓解时间、总体疗效评价、内镜复查情况及药物不良反应。结果治疗组腹泻缓解率和总体疗效评估显效率明显高于对照组,差异有显著性（P〈0．05）;而内镜下复查结果两组比较无显著性差异（P〉0．05）;安全性研究未发现不良反应。结论枯草杆菌肠球菌二联活菌胶囊能显著改善AAD患者的临床症状并缩短病程,是治疗AAD较理想的药物。