Covino Marcello, Gallo Antonella, Rognoni Fiammetta Maria, Parlangeli Maria Caterina, Simeoni Benedetta, Franceschi Francesco, Landi Francesco, Montalto Massimo
Department of Emergency Medicine, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Rome, Italy.
Department of Emergency Medicine, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
Antibiotics (Basel). 2024 Sep 16;13(9):891. doi: 10.3390/antibiotics13090891.
Acute diarrhea represents a major public health issue, and the management of adult patients admitted to the emergency department (ED) for this problem is still challenging. In a retrospective analysis on more than 20,000 patients visiting a tertiary ED for acute diarrhea and then being discharged home, we found that age > 65 years, onset of symptoms > 24 h since ED admission, refusal of hospitalization, and a history of chronic renal and liver diseases were independently associated with ED readmission for abdominal symptoms within 7 days. In the younger group, the presence of comorbidities significantly impacted on ED readmission, while fever and alteration of serum creatinine were the main determinants in the older group. Antibiotics were prescribed in about 25% of patients, although diarrhea etiology (viral or bacterial) was usually not available. According to international guidelines, fluoroquinolones were the most prescribed class, showing an inverse correlation to ED readmission. However, β-lactams and probiotics were also commonly prescribed; the latter were independently correlated to ED readmission in the elderly group. A comprehensive, guideline-based approach, including a detailed clinical history and laboratory and comorbidity assessment, should be encouraged to support physicians in the management of different age subgroups of adults admitted to the ED for acute diarrhea.
急性腹泻是一个重大的公共卫生问题，对于因该问题入住急诊科（ED）的成年患者进行管理仍具有挑战性。在一项对20000多名因急性腹泻前往三级急诊科就诊后出院回家的患者的回顾性分析中，我们发现年龄>65岁、自入住急诊科后症状出现>24小时、拒绝住院以及有慢性肾病史和肝脏病史与7天内因腹部症状再次入住急诊科独立相关。在较年轻的组中，合并症的存在对再次入住急诊科有显著影响，而发热和血清肌酐改变是较年长组的主要决定因素。约25%的患者使用了抗生素，尽管腹泻病因（病毒或细菌）通常并不明确。根据国际指南，氟喹诺酮类是最常使用的类别，与再次入住急诊科呈负相关。然而，β-内酰胺类和益生菌也经常被使用；后者在老年组中与再次入住急诊科独立相关。应鼓励采用基于指南的综合方法，包括详细的临床病史以及实验室和合并症评估，以支持医生对因急性腹泻入住急诊科的不同年龄亚组成年患者进行管理。
