Investigation Of Current Situation Of Antibiotic-associated Diarrhea In ICU And Analysis Of Related Factors

【objective】Through the comparative analysis of the medical records of 74 AAD patients and 142 non-AAD patients in the intensive care unit,the occurrence of AAD in the intensive care unit was understood,and the related risk factors of AAD in the critical care unit were discussed,so as to provide a good basis for clinical prevention and treatment.【method】Patients who were admitted to the emergency intensive care department and the intensive care internal medicine department of the hospital from October,2017 to October,2018 and met the inclusion criteria were divided into AAD group and non-aad group according to the presence or absence of diarrhea.Collection of two groups of patients with the following information: gender,age,the use of antibiotics,the kinds of species number,whether combination antibiotics,whether to have diabetes,whether enteral nutrition,endotracheal intubation,combined antifungal medicine,APACHE II score,routine blood leukocyte count,ALT,Cr,whether exist prior whether to use probiotics to prevent diarrhea,diarrhea,whether hormone therapy,average hospitalization days,persistent diarrhea days,always diarrhea,infection site,excrement and urine routine inspection situation,excrement and urine specimens were difficult bacteria,fecal training inspection situation.According to the data,calculate the following general indicators: the incidence of AAD the diarrhea rate,rate of antibiotics,patients with AAD days,average diarrhea,persistent diarrhea,stool routine inspection rate and the abnormal rate,rate of stool specimens were difficult bacteria and cultivate positive rate,excrement and urine inspection rate,positive rate and the antibiotics diarrhea rate,in order to understand the current intensive AAD status;Finally,after the normality test and homogeneity of variance test,the paired sample t test was performed for the obtained counting data.Chi-square test was performed for comparison of classification variables.Finally,univariate logistic regression analysis was performed for each variable,and all variables with P < 0.05 in univariate analysis were included in the unconditioned logistic regression model to determine independent risk factors related to AAD.【results】1.In this study,the incidence of AAD was 34.26%,the antibiotic combination rate was 49.54%,the average diarrhea frequency was 4.17 times per day,the median diarrhea frequency was 3.6 times per day,the average diarrhea days were 7.14 days,the median diarrhea days were 6 days,the average diarrhea days were 4.35 days,and the median diarrhea days were 3 days.The routine fecal examination rate was 78.38%,the abnormal fecal examination rate was 10.34%,the fecal clostridium difficile specimen examination rate was 10.81%,the fecal clostridium difficile antigen positive rate was 25%,the toxin positive rate was 0,the fecal culture examination rate was 20.27%,and the fecal culture positive rate was 26.67%.2.Age(OR 1.030,95%ci(1.002-1.058)),mean antibiotic use(OR 0.723,95%ci(0.525-0.966)),APACHE II score(OR 1.209,95%ci(1.096-1.333)),and mean hospital stay(OR 1.181,95%ci(1.114-1.251))were independent risk factors for the occurrence of AAD in critically ill patients(P < 0.05).Gender,combination of antibiotics,diabetes,enteral nutrition,endotracheal intubation,antifungal agents,leukocyte count,ALT,Cr,tumor co-existence,probiotics to prevent diarrhea before diarrhea,and hormone therapy were independent risk factors for the occurrence of AAD in severe patients(P 0.05).3.The study of 216 use of antibiotics in the ICU inpatients,pulmonary infection,210 cases(97.22%),urinary tract infection in 36 cases(16.67%),51 cases of sepsis(23.61%),8 cases of biliary tract infection,intracranial infection(3 cases),heart infection in 5 cases,6 cases of skin soft tissue infection,bone marrow infection,infection of the uterus,lumbar muscle abscess in 1 case.4.Diarrhea rates of antibiotics in this study: Tegacycline 75%,ertapenem 66.7%,piperacillin sodium,tazobactam 56.36%,levofloxacin 55%,vancomycin 50%,teicolanine 47.5%,cefoperazone sodium,sulbactam 42.39%,linidazolam 40%,meropenem 39.29%,moxifloxacin 32.94%,ceftazidime 31.25%,imipenem 26.67%,ceftriaxone 14.27%,ornidazole 9.09% 【conclusion】1.At present,the incidence of AAD in intensive care unit is high,the rate of antibiotic combination is high,and the rate of fecal culture specimens,clostridium difficile specimens and positive rate are low.2.Age,average antibiotic use,APACHE II score,and average hospital stay were independent risk factors for the occurrence of AAD in severe patients.In other words,the older the patient is,the less antibiotics applied,the higher the APACHE II score,the longer the hospital stay,and the more likely the severe patient is to have AAD.