急性淋巴细胞白血病合并抗菌药物相关腹泻一例

目的探讨抗菌药物相关腹泻的临床特征、实验室检查及治疗方法。 方法回顾性分析联勤保障部队第960医院2017年收治的1例急性淋巴细胞白血病患者合并抗菌药物相关腹泻患者的病例资料和诊疗过程。 结果患者经过多次化疗，在行造血干细胞移植术前予以抗菌药物治疗以清洁肠道、预防感染，使用抗菌药物后发生腹泻、高热、恶心、呕吐；实验室检查：粪便涂片可见革兰阳性芽孢杆菌，疑似梭样芽孢杆菌；艰难梭菌抗原阳性、毒素阳性。及时停用抗菌药物，加用盐酸万古霉素和相应的补液、营养、调节菌群等对症治疗，腹泻症状逐渐缓解。 结论长期住院、免疫力低下及长期使用抗菌药物为抗菌药物相关性腹泻的重要危险因素，应合理规范的使用抗菌药物，准确及时检查诊断、进行正规治疗。

A case with acute lymphoblastic leukemia and antibiotic associated diarrhea

ObjectiveTo investigate the clinical features, laboratory examination and treatment of antimicrobial-associated diarrhea. MethodsA case of acute lymphoblastic leukemia (ALL) complicated with antimicrobial drug-associated diarrhea (ACD) in General Hospital of Jinan Military Area in 2017 was analyzed, retrospectively. ResultsAfter repeated chemotherapy, the patient was treated with antibiotics before hematopoietic stem cell transplantation to clean the intestine and prevent infection. The patient occurred diarrhea, high fever, nausea and vomiting after the use of antimicrobial agents. Laboratory examination: Gram-positive bacillus was found in fecal smears, suspected clostridium; with Clostridium difficile antigen and toxin positive. The symptoms of diarrhea were gradually alleviated when antibiotics were suspended in clinical practice, and treated with vancomycin hydrochloride and corresponding rehydration, nutrition, microflora regulation and other corresponding symptomatic measures. ConclusionsLong-term hospitalization, low immunity and long-term use of antimicrobial agents were important risk factors for antimicrobial associated diarrhea. The use of antibiotics should be reasonably standardized, accurate and timely examinated and diagnosed, and regular regimen should be taken.