益生菌在抗生素相关性腹泻中的应用：养老院中的实用参与式评估。
Probiotics use for antibiotic-associated diarrhea: a pragmatic participatory evaluation in nursing homes.
机构信息
Department Nutrition & Health, Louis Bolk Institute, Kosterijland 3-5, 3981, Bunnik, AJ, The Netherlands.
Van Praag Institute, Springweg 7, 3511, Utrecht, VH, The Netherlands.
出版信息
BMC Gastroenterol. 2020 May 13;20(1):151. doi: 10.1186/s12876-020-01297-w.
BACKGROUND
Antibiotic-associated diarrhea (AAD) occurs in 2-25% of nursing home residents, which may lead to dehydration, malnutrition, severe complications and hospitalizations. Research shows that probiotics can be effective and safe in reducing AAD. However, probiotics are not routinely used in Dutch nursing homes. The objectives of this evaluation were to develop a procedure for the implementation of probiotics to prevent AAD in nursing homes, to evaluate effects on AAD occurrence, and to evaluate the implementation process of probiotics in daily care.
METHODS
A pragmatic participatory evaluation (PPE) design was chosen, as it seemed a suitable approach for implementation of probiotics, as well as for evaluation of its effectiveness in daily nursing home practice. Probiotics administration was implemented in three nursing homes of the Rivas Zorggroep for residents with somatic and/or psychogeriatric conditions. Ninety-three residents provided data on 167 episodes of antibiotics use, of which 84 episodes that included supplementation with probiotics and 83 episodes with no probiotics supplementation. A multispecies probiotics was administered twice daily upon start of antibiotic treatment, up to 1 week after completing the antibiotics course. The occurrence of AAD was monitored and a process evaluation was conducted to assess facilitators and barriers of probiotics implementation.
RESULTS
The number of episodes with AAD when using probiotics was significantly lower than when no probiotics was used (20% vs 36%; p = 0,022, Chi-square). No significant differences in the occurrence of AAD were found between the residents taking amoxicillin/clavulanic acid or ciprofloxacin. Reported facilitators for implementation were perceived benefits of probiotics and prescription by medical staff. Reported challenges were probiotics intake by residents and individual decision-making as to which resident would benefit from it.
CONCLUSION
Successful implementation of probiotics demonstrated the prevention of AAD in nursing home residents.
TRIAL REGISTRATION
ISRCTN 94786163, retrospectively registered on 3 February 2020.
背景
抗生素相关性腹泻（AAD）在养老院居民中的发生率为 2-25%，可能导致脱水、营养不良、严重并发症和住院。研究表明，益生菌在减少 AAD 方面是有效且安全的。然而，益生菌在荷兰养老院并未常规使用。本评估的目的是制定一项在养老院中使用益生菌预防 AAD 的实施程序，评估其对 AAD 发生的影响，并评估益生菌在日常护理中的实施过程。
方法
选择了一种实用的参与式评估（PPE）设计，因为它似乎是在养老院实施益生菌以及评估其在日常护理实践中的有效性的合适方法。在 Rivas Zorggroep 的三家养老院中，为患有躯体和/或精神老年病的居民实施益生菌管理。93 名居民提供了 167 次抗生素使用的数据，其中 84 次使用了益生菌补充剂，83 次没有使用益生菌补充剂。在开始使用抗生素治疗时，每天两次给予多菌种益生菌，直到抗生素疗程结束后 1 周。监测 AAD 的发生，并进行了过程评估，以评估益生菌实施的促进因素和障碍。
结果
使用益生菌时发生 AAD 的次数明显低于未使用益生菌时（20%比 36%；p=0.022，卡方检验）。服用阿莫西林/克拉维酸或环丙沙星的居民中，AAD 的发生无显著差异。实施的促进因素包括益生菌的预期益处和医务人员的处方。报告的挑战是居民摄入益生菌和个人决策，即哪些居民将从中受益。
结论
益生菌的成功实施证明了它可以预防养老院居民的 AAD。
试验注册
ISRCTN 94786163，于 2020 年 2 月 3 日回顾性注册。
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