Takedani Yoko, Nakamura Tsukasa, Fukiwake Noriko, Imada Toshihiro, Mashino Junji, Morimoto Takeshi
Department of General Medicine, Shimane Prefectural Central Hospital, Izumo, Japan.
Department of Infectious Diseases, Shimane Prefectural Central Hospital, Izumo, Japan.
BMC Geriatr. 2021 May 17;21(1):317. doi: 10.1186/s12877-021-02267-x.
Antibiotic-associated diarrhea (AAD) is a common problem among elderly inpatients because many elderly patients are admitted for pneumonia or other conditions that necessitate antibiotic treatment. In the super aging population, more patients are suffering from pneumonia than before, but the incidence or risk factors for AAD among many elderly patients have not been well scrutinized.
We conducted a retrospective cohort study of elderly patients diagnosed with pneumonia from April 2014 to March 2019 who were admitted to the Department of General Medicine of a Tertiary Care Hospital in Japan. Patients (≥ 65 years of age) who were diagnosed with bacterial pneumonia or aspiration pneumonia and treated with antibiotics were included. We defined AAD by diarrhea with more than three loose or watery stools per day and included patients who had these symptoms for either one day or two or more consecutive days. We also assessed the length of hospital stay and in-hospital mortality. The potential risk factors for AAD included age, sex, body weight, body mass index, smoking, alcohol, activities of daily living (ADL), comorbidities, vital signs, laboratories, the severity of pneumonia, antibiotic and other medication use.
There were 1,067 patients, the mean age was 83 years, and men accounted for 59 %. β-Lactamase inhibitors were frequently prescribed antibiotics in 703 patients (66 %), and proton pump inhibitors (PPIs) were also commonly administered (48 %). AAD developed in 322 patients (30 %). The multivariate logistic regression model showed that β-lactamase inhibitors (OR 1.43, 95 % CI 1.05-1.95) and PPIs (OR 1.37, 95 % CI 1.03-1.83) were associated with AAD as well as age (OR 1.03 per year, 95 % CI 1.01-1.05).
AAD was common among elderly inpatients with pneumonia, and β-lactamase inhibitors and PPIs were associated with AAD. Strict use of such medication should be considered to decrease the risk of AAD.
抗生素相关性腹泻（AAD）是老年住院患者中的常见问题，因为许多老年患者因肺炎或其他需要抗生素治疗的疾病而入院。在超老龄化人群中，患肺炎的患者比以前更多，但许多老年患者中AAD的发病率或危险因素尚未得到充分研究。
我们对2014年4月至2019年3月在日本一家三级护理医院普通内科住院的诊断为肺炎的老年患者进行了一项回顾性队列研究。纳入诊断为细菌性肺炎或吸入性肺炎并接受抗生素治疗的患者（≥65岁）。我们将AAD定义为每天腹泻超过三次稀便或水样便，并纳入有这些症状一天或连续两天或更多天的患者。我们还评估了住院时间和院内死亡率。AAD的潜在危险因素包括年龄、性别、体重、体重指数、吸烟、饮酒、日常生活活动能力（ADL）、合并症、生命体征、实验室检查、肺炎严重程度、抗生素及其他药物使用情况。
共有1067例患者，平均年龄83岁，男性占59%。703例患者（66%）经常使用β-内酰胺酶抑制剂作为抗生素，质子泵抑制剂（PPI）也普遍使用（48%）。322例患者（30%）发生了AAD。多因素逻辑回归模型显示，β-内酰胺酶抑制剂（比值比[OR]1.43，95%置信区间[CI]1.05-1.95）和PPI（OR 1.37，95%CI 1.03-1.83）以及年龄（每年OR 1.03，95%CI 1.01-1.05）与AAD相关。
AAD在老年肺炎住院患者中很常见，β-内酰胺酶抑制剂和PPI与AAD相关。应考虑严格使用此类药物以降低AAD的风险。
