Management of patients presenting with diarrhoea to a regional emergency department in KwaZulu-Natal: Call for clearer, more relevant guidance
Management of patients presenting with diarrhoea to a regional emergency department in KwaZulu-Natal: Call for clearer, more relevant guidance
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DOI：
10.7196/sajhivmed.1082
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发表时间：
2014-09-01
影响因子：
1.7
通讯作者：
Azarath, A
中科院分区：
文献类型：
--
作者：
Kudsk-Iversen, S;Gilbert, J P;Azarath, A
背景资料。HIV在整个南非都很流行，无论是HIV感染者还是非感染者，腹泻都是急诊科(ED)常见的表现。我们对照夸祖鲁-纳塔尔一家地区医院急诊科的标准指南对腹泻的管理进行了审计。以腹泻为主诉的患者符合条件，数据收集具有前瞻性。共纳入72例患者，其中58例(81%)为HIV阳性，平均CD_4~+细胞数为180个/亩L。共34份粪便标本送标准镜检和培养(M&C)，其中26份阳性(76%)。43例(60%)患者接受了抗生素治疗，其中15例粪便M&C阳性，最终诊断为急性胃肠炎，未作进一步说明，按指南用药不一致。基于这次审计，我们认为，目前的指导方针对艾滋病毒感染者急性腹泻的管理不明确，缺乏明确的管理战略可能会影响患者的安全，并增加抗生素耐药性。
Background. HIV is prevalent throughout South Africa, and diarrhoea is a common presentation to the emergency department (ED) among both HIV-infected and -uninfected individuals.Method. We audited the management of diarrhoea against standard guidelines in the ED of a regional hospital in KwaZulu-Natal. Patients presenting with diarrhoea as their chief complaint were eligible and data were collected prospectively.Results. A total of 72 patients were included: 58 (81%) of patients were HIV-positive with an average CD4(+) count of 180 cells/mu l. A total of 34 stool samples were sent for standard microscopy and culture (M&C), among which 26 were positive (76%). Forty-three patients (60%) received antibiotics, 15 of whom had positive stool M&C. In all cases, the final diagnosis was listed as acute gastroenteritis without further specification, and antibiotic use according to guidelines appeared inconsistent.Conclusion. Based on this audit, we suggest that current guidelines are not clear concerning management of acute diarrhoea in HIV-infected individuals, and that the lack of clear management strategies is likely to affect patient safety and increase antibiotic resistance.