2018 年第 9 期 第 13 卷

重症复杂性抗菌药物相关性腹泻诊治分析

Diagnosis and treatment of severe complex antibiotic-associated diarrhea

作者：郭利涛朱芝静刘昱张蕾孙婧婧雷金娥

英文作者：

单位：710061西安交通大学第一附属医院重症医学科（郭利涛、朱芝静、刘昱、张蕾、孙婧婧），检验科（雷金娥）

英文单位：

关键词：抗菌药物相关性腹泻；艰难梭菌；重症监护病房；抗菌药物

英文关键词：

• 摘要：

• 【摘要】目的    分析重症复杂性抗菌药物相关性腹泻 (AAD)的个体化治疗策略，为提高救治成功率提供参考。方法    回顾性分析2017年11月西安交通大学第一附属医院重症医学科成功诊治1例复杂性AAD患者的临床资料，对患者临床、病原学资料、抗菌药物使用及艰难梭菌的监测和治疗情况进行分析。结果    患者较长时间使用广谱抗菌药物出现腹泻，大便每日10余次，粪涂片示革兰阳性球菌、革兰阴性杆菌比例严重失调，艰难梭菌毒素监测阳性，诊断为AAD。患者病情危重，初次治疗给予口服万古霉素好转，但因未完成规定疗程，过早停用万古霉素致AAD复发，明确为复杂性AAD。复发治疗中根据患者情况给予大剂量万古霉素口服及灌肠，并根据患者个体情况调整治疗方案。最终好转出院，随访1个月余未见复发，未见万古霉素相关不良反应。结论    对于重症患者发生复杂性AAD时应给予长疗程万古霉素治疗，并根据患者情况及治疗效果及时调整治疗方案，实现精准化、个体化治疗，提高重症患者复杂性AAD的救治成功率。

• 【Abstract】Objective    To analyze the individual treatment strategy for severe complex antibiotic-associated diarrhea(AAD) and provide reference for improving the rescue rate in critically ill patients. Methods    One case of complex AAD was diagnosed in November 2017 at Intensive Care Unit(ICU) of the First Affiliated Hospital of Xi′an Jiaotong University. Clinical and etiological data, use of antibacterials, detection result of Clostridium difficile and the treatment strategy were analyzed. Results    The patient had been treated with a long course of broad-spectrum antibiotics; diarrhea occurred more than 10 times a day. Stool smear showed severe imbalance of gram-positive cocci/gram-negative bacilli and positive result of Clostridium difficile infection. During the critical stage of disease, the patient was treated with oral vancomycin initially and recovered well. However, due to premature cessation of vancomycin, AAD relapsed and the patient was diagnosed of complex AAD. After AAD relapse, the patient was treated with a special individual strategy using high dose of oral vancomycin and enema and recovered well. No recurrence and vancomycin-related adverse reaction occurred during the follow-up of more than 1 month. Conclusion    Complex AAD should be treated with long course of vancomycin based on the individual condition to improve the rescue rate in ICU patients.