老年住院患者抗生素相关性腹泻调查

目的 探讨老年住院患者抗生素相关天性腹泻(AAD)的发病持点、危险因素及其防治策略。方法 对2003年2月1日住在本院的33l例老年患者进行回顾性调查，分析其在此后1个月内发生AAD的情况。结果 使用抗生素的248例老年住院患者中有6l例(100例次)发生AAD，发生率23.70％。AAD与使用抗生素种类、联合用药数量及疗程、住院天数、疾病严重程度、采用医疗干预措施等危险因素有关。较易引起AAD的抗生素为广谱青霉素或加酶抑制剂(21.62％)、第四代头孢菌素类(20.59％)、第三代头孢菌素类(20.45％)、碳青霉烯类(20.0％)等。所有AAD患者，在积级治疗基础疾锅的同时，经停用、减量、换用抗生素，服用微生态制剂，加强支持治疗后，痊愈及好转者48例(78例次)，有效百分率78％；复发者13例(2l例次)，复发百分率3l％，治疗无效者12例(2l例次)，无效百分率2l％；死亡l例,病死百分率l％。结论 只有提高临床医生对AAD的认识，加强预防措施，合理使用抗生素，才能有效地减少住院老年患者AAD的发生率.

INVESTIGATION OF ANTIBIOTIC ASSOCIATED DIARRHEA IN HOSPITALIZED ELDERLY PATIENTS

Objective To evaluate the characteristics,the risk factors of the antibiotic associated diarrhea(AAD) in hospitalized elderly patients and their preventive and therapeutic measures. Methods 331 patients of AAD,being in hospital at Feb 1, 2003,were studied retrospectively and analysed prospectively 1 month later. Results 61 patients(100 cases)using antibiotics resulted in AAD, prevalence ratio 23.70% .the risk factors of AAD were related to the kinds of using mix antibiotics and period of treatment, the time being in hospital,the grievorsly degree of disease,using many meddle measures for medical treatment. The antibiotics causing AAD easily were extending penicillins(21.62%),fourth cephalosporins(20.59%), third cephalosporins(20.45%), carbapenemases(20.0%).61 patients(100 cases) were cured,and at the same time,48 patients(78 cases) discontinuation ,reducing or replacement of the inciting antibitic,taking microorganism preparation strengthening sustain treatment,the effective rate was 78%;13 patients(21 cases) were recurred,recurrence rate was 21%;12 patients(21 cases) were of no effect,account for 21%;1 patients was dead,case-fatality rate was 1%. Conclusions It is important for physician to reduce availably the incidence of AAD in hospitalized elderly patients by enhance understanding about AAD, strengthen preventive measures,use antibiotics reasonably.