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词汇介绍
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解析
antibiotic 英 [,æntɪbaɪ'ɒtɪk] 美 [,æntɪbaɪ'ɑtɪk; ˌæntaɪ-]
释义 adj. 抗生的;抗菌的 n. 抗生素,抗菌素
例句 This can lead to problems with your body resisting antibiotic treatment. 这可能会导致问题,你的身体抵抗抗生素治疗。
associated [ə'soʃɪetɪd]
释义 v. 联系 adj. 关联的;联合的
例句 Chills are often associated with fever. 寒颤常伴有发热。
diarrhea 英 [,daɪə'riə] 美 [,daɪə'riə]
释义 n. 腹泻,痢疾
例句 Never prepare food for others if you have diarrhea or vomiting. 如果你腹泻或呕吐,千万不要为他人准备食物。
概述
概述
抗生素相关性腹泻(antibiotic associated diarrhea,AAD)主要是指使用抗生素后导致肠道菌群紊乱而引起的腹泻,同时也包括抗生素本身的毒副作用导致的腹泻。近年来由于抗生素广泛使用,甚至滥用,AAD有明显增多。
病因及发病机制
抗生素相关性腹泻的病因、发病机制复杂,目前尚未完全清楚,常见的原因有:
(1)抗生素使用后的肠道菌群紊乱;
(2)抗生素干扰糖和胆汁酸代谢;
(3)抗生素的变态反应,毒性作用对肠道黏膜的直接作用。
(4)药理效应致肠道动力的改变
临床表现
AAD以腹泻为主要表现,其临床症状可轻可重。轻型患者仅表现解稀便2~3次/天,持续时间短,没有因腹泻而发生中毒症状;中等型患者临床腹泻次数较多,大便可出现红、白细胞,值得注意的是该型易被诊断为感染性腹泻而不断使用大剂量广谱抗生素,其结果导致抗生素与腹泻形成恶性循环,病情发展;重型患者临床症状重,常腹泻水样便10~20次/d,假膜性肠炎(PMC)大便中可见漂浮的假膜,可伴发热、腹部不适、里急后重。少数极其严重者(如爆发性结肠炎)除有腹泻外还可发生脱水、电解质紊乱、低蛋白质血症或败血症等,甚至出现中毒性巨结肠而表现高热、恶心呕吐及肠鸣音减弱,胃肠功能衰竭,此时腹泻可能停止,也可能发生肠穿孔。
实验室检查
(1)大便常规检查;
(2)肠道菌群失调的检查 ①大便直接涂片革兰染色观察法;②肠道各种细菌定量培养法;
(3)针对继发细菌感染的特定检查;
(4)其他相关检查。
诊断
无腹泻患者诊断:在使用抗生素后发生腹泻并能排除基础疾病或其它相关原因所致的腹泻,此情况均要考虑AAD诊断;若同时有肠道菌群紊乱证据,则诊断AAD基本成立。
腹泻患者诊断:抗生素使用后出现严重腹泻,不但有肠道菌群紊乱证据,而且出现大量机会菌变为优势菌或检出特殊病原菌(CD、金黄色葡萄球菌、白色念珠菌)感染证据也是诊断AAD的有力证据。
治疗
(1)立即停用抗生素或调整抗生素;
(2)补充益生菌,恢复肠道正常菌群;
(3)加强对症支持治疗;
(4)保护肠道粘膜;
(5)针对AAD中特殊细菌感染治疗。
预防
(1)严格掌握使用抗生素的指征;
(2)选用对肠道菌群影响较小的药物;
(3)使用微生态制剂预防AAD;
(4)尽可能避免使用对肠道有损伤的检查和治疗。
Reuteri乳杆菌DSM 17938预防儿童抗生素相关性腹泻: 一项随机临床试验
发表时间:2018-08-24
影响指数:6.4
作者: M. Kołodziej
期刊:Clinical Microbiology and Infection
Antibiotic-associated diarrhoea (AAD) refers to unexplained diarrhoea that occurs in association with antibiotic therapy, after the exclusion of other possible aetiologies [1]. The frequency of AAD varies depending on the definitions used; it ranges from 4.3% to 80%, with a median incidence of 22%, and the mean age of patients with AAD ranges from 18 to 48 months [2]. In children, the main risk factors for AAD include the age of the child and the type of antibiotic used [2]. AAD may occur just a few hours after antibiotic administration or up to 8 weeks after antibiotic administration [3], and it is associated with increased costs and length of hospital stay [4]. The mechanism of AAD is not fully understood. One of the potential mechanisms is a direct effect of the antibiotics on the intestinal mucosa, resulting in alterations in the gut microbiota composition and the overgrowth of pathogens. Clostridium difficile is the most common infectious cause of AAD[5]. However, other pathogens such as Staphylococcus, Candida, Enterobacteriaceae and Klebsiella, may be involved[6]. The clinical manifestations of AAD range from mild diarrhoea to colitis or fulminant pseudomembranous colitis [7]. Compared with adults, children typically become symptomatic more rapidly. However, their recovery is quicker, they suffer fewer complications, and their duration of disease is shorter compared with adults [2].
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