三级医院急诊科的急性腹泻:从再入院决定因素到抗生素处方

Marcello Covino, Antonella Gallo, Fiammetta Maria Rognoni, Maria Caterina Parlangeli, Benedetta Simeoni, Francesco Franceschi, Francesco Landi, Massimo Montalto
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引用次数: 0

摘要

急性腹泻是一个重大的公共卫生问题,而急诊科(ED)收治的急性腹泻成人患者的管理仍面临挑战。我们对 2 万多名因急性腹泻到三级急诊科就诊并出院回家的患者进行了回顾性分析,结果发现,年龄大于 65 岁、入院后症状出现时间大于 24 小时、拒绝住院以及有慢性肾病和肝病病史与急诊科在 7 天内因腹部症状再次入院密切相关。在年轻人组中,合并症的存在对急诊室再入院有显著影响,而在老年人组中,发热和血清肌酐变化是主要的决定因素。约有 25% 的患者使用了抗生素,但通常无法提供腹泻的病因(病毒或细菌)。根据国际指南,氟喹诺酮类是处方最多的一类抗生素,与急诊室再入院率呈反向关系。不过,β-内酰胺类药物和益生菌也是常用处方;后者与老年人组的急诊室再入院率呈独立相关性。应以指南为基础的综合方法(包括详细的临床病史、实验室和并发症评估)应得到鼓励,以支持医生对因急性腹泻而被急诊室收治的不同年龄亚组成人进行管理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Acute Diarrhea in a Tertiary Emergency Department: From Readmission Determinants to Antibiotic Prescription
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.
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