BackgroundWe analyzed the factors related to AAD to inform the rational use of antibiotics in critically ill patients and to reduce the incidence of AAD by providing a reference for antibiotic use in the clinical setting.Material/MethodsThis study was a retrospective analysis of the clinical data of patients who were hospitalized in the ICU of the First Teaching Hospital of Xi’an Jiaotong University from January 1, 2015 to December 31, 2016. Patients with AAD were assigned to the case group, and all others were assigned to the control group. Basic data were collected for all the selected patients. All the relevant data were analyzed with univariate or multivariate regression analyses, and P<0.05 was considered statistical significance.ResultsA total of 293 patients were enrolled. Statistical analyses showed that gender (OR 1.915; 95% [CI] 1.061–3.455; P=0.031), parenteral nutrition (OR 1.877; 95% [CI] 1.043–3.377; P=0.036), preventive use of probiotics (OR 0.497; 95% [CI] 0.285–0.866; P=0.014), APACHE II score upon admission to the ICU (OR 0.961; 95% [CI] 0.927–0.998; P=0.037) and use of enzyme-inhibitor antibiotics (OR 1.899; 95% [CI] 1.044–3.420; P=0.016) were associated with AAD. Further subgroup analysis by gender showed that parenteral nutrition (OR 2.144; 95% [CI] 1.064–4.322; P=0.033), preventive use of probiotics (OR 0.367; 95% [CI] 0.186–0.722; P=0.004), and APACHE II score upon admission to the ICU (OR 1.055; 95% [CI] 1.011–1.101; P=0.014) were associated with AAD in critically ill male patients. Age (OR 0.975; 95% [CI] 0.951–0.999; P=0.041) and use of carbapenem antibiotics (OR 4.826; 95% [CI] 1.011–23.030; P=0.048) were associated with AAD in critically ill female patients.ConclusionsParenteral nutrition, prophylactic use of probiotics, use of enzyme-inhibitor antibiotics, and use of combinations of antibiotics were associated with AAD in critically ill patients. The prophylactic use of probiotics may be a protective factor in AAD.

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Background: The widespread use of antibiotics has resulted in a high incidence of antibiotic-associated diarrhea (AAD); moreover, the AAD-associated mortality rates have also increased. The effect of combined antibiotic administration on AAD in critically ill patients was analyzed to assist in antibiotic selection for AAD prevention. Methods: Clinical data of patients hospitalized were retrospectively analyzed. Patients were either assigned to the combined-use group (CG) or the monotherapy group (MG). Age, sex, albumin levels, proton pump inhibitors, the type antibiotics, occurrence of AAD were collected. All relevant data were analyzed using SPSS version 18.0 (IBM Inc., Armonk, NY, USA), and significance was set at P <0.05. Measurements and main results: Overall, 277 patients were enrolled (CG, n=143; MG, n=134). The incidence of AAD was significantly different between the groups (44.06% vs 17.16%, P <0.001). Combined use of three or more antibiotics, other antibiotics combined with antifungals antibiotics increases the incidence of AAD ( P <0.05). Duration of proton pump inhibitor therapy (odds ratio [OR] 1.142, 95% confidence interval [CI] 1.048–1.244, P =0.002), antifungal antibiotic administration (OR 3.189, 95% CI 1.314–7.740, P =0.010), and beta-lactam plus enzyme inhibitor antibiotic administration (OR 3.072, 95% CI 1.309–7.205, P =0.010) were associated with AAD in critically ill patients receiving combined antibiotics therapy. The mean duration of intensive care unit admission was longer among patients with AAD compared with patients without AAD (19.70±12.16 vs 12.29±8.06 days, P <0.001), with no significant difference in intensive care unit-related mortality rates. Conclusion: Combined administration of antibiotics, especially beta-lactam plus enzyme inhibitors and antifungals, may increase the incidence of AAD in critically ill patients.

BackgroundThis study aimed to analyze the factors associated with the development of antibiotic-associated diarrhea (AAD) in critically ill patients receiving enzyme inhibitor antibiotics.Material/MethodsA retrospective study of patients with and without AAD admitted to the intensive care unit (ICU) of the First Teaching Hospital of Xi’an Jiaotong University from February 1, 2014, to January 31, 2016, was undertaken. Relevant clinical data underwent univariate or multivariate regression analysis.ResultsOf 184 patients who received enzyme inhibitor antibiotic therapy, 70 patients (38.04%) developed AAD, with a mean duration of onset of 6.97±3.64 days. AAD was associated with the use of enzyme inhibitor antibiotic therapy alone (OR, 1.142; 95% CI, 1.038–1.256; P=0.007), and in combination with antifungal agents (OR, 2.449; 95% CI, 1.116–5.372; P=0.025), quinolones (OR, 5.219; 95% CI, 1.746–15.601; P=0.003), and oxazolidinones (OR 2.895; 95% CI, 1.183–7.083; P=0.020). The mean duration of ICU stay was significantly increased in patients with AAD (19.00±11.49 days vs. 9.60±6.76 days) (P<0.001). Mean duration of antibiotic therapy (14.09±8.82 days vs. 8.10±4.91 days) (P<0.001) and duration of enzyme inhibitor antibiotic therapy (9.26±5.06 days vs. 6.61±3.24 days) (P<0.001) were significantly increased in patients with AAD.ConclusionsDuration of use of enzyme inhibitor antibiotic therapy and the combined use of antifungals, quinolones, and oxazolidinones increased the incidence and duration of AAD and increased the length of stay in ICU.

The dipping variations of circadian blood pressure (BP) correlate closely with target-organ damages and cardiovascular events. The aim of this study was to investigate the relationship between BP reverse dipping and the prevalence of stable coronary artery disease (sCAD) in hypertensive patients. Clinical data and the results of 24-hour ambulatory BP monitoring (ABPM) were obtained from 718 hypertensive patients (390 males, mean age 59.6 ± 13.8 years) in a single centre in Northern China. Reverse dipping pattern was defined as nocturnal systolic BP (SBP) was higher than daytime SBP. A logistic regression model was applied to explore the independent risk factors of sCAD. The patients with BP reverse dipping accounted for 31.5% in sCAD group and 19.5% in control group (P < 0.05). In multivariate analysis, BP reverse dipping remained significantly associated with the prevalence of sCAD (Odds ratio [OR], 1.772; p = 0.027). Furthermore, the circadian decline rate of SBP was independently associated with sCAD (OR, 0.975; p = 0.043). The hypertensive patients with reverse BP dipping were found to be more frequently suffering from sCAD. BP reverse dipping examined with 24-hour ABPM may indicate sCAD.