Ikeda K, Ida O, Kimoto K, Takatorige T, Nakanishi N, Tatara K
Osaka University, Graduate School of Medicine, Department of Social and Environmental Medicine, Suita City, Japan.
Clin Nephrol. 1999 Dec;52(6):357-62.
To clarify the effect of early fosfomycin treatment, an antimicrobial agent in common use in Japan, on children with E. coli O157 with the aim of preventing hemolytic uremic syndrome (HUS).
Non-randomized prospective study for development of HUS among inpatients with E. coli O157.
The hospitals where the 292 inpatients were treated.
A total of 292 inpatients aged six to eleven years with E. coli O157 infection, 36 (12.3%) of whom were HUS cases.
Most of the HUS inpatients (91.7%) developed this complication between the sixth and ninth day of illness. We therefore analyzed the effects of antimicrobial therapy, especially that of fosfomycin, on prevention of HUS within the first five days of illness, because fosfomycin was the most frequently used (88.0%). To clarify the effect of fosfomycin alone on prevention of HUS, we carried out an analysis using the data for 130 inpatients who received fosfomycin alone or did not receive any antimicrobial agents, within the first five days of illness. multivariate analysis, controlled for age, gender and presence of fever, showed that all adjusted odds ratios for the development of HUS with the use of fosfomycin within the first three days of illness were less than 1.0, with the use of fosfomycin on the second day of illness achieving statistical significance (adjusted OR, 0.09; 95% CI, 0.01-0.79). Furthermore, inpatients who took fosfomycin within the first two days of illness developed HUS significantly less often than those who did not (adjusted OR, 0.15; 95% CI, 0.03-0.78). On the other hand, fosfomycin therapy on and after the third day of illness was not associated with the prevention of HUS.
The early use of fosfomycin within the first two days of illness might prevent the development of HUS.
阐明日本常用抗菌药物早期使用磷霉素治疗对感染大肠杆菌O157的儿童的影响，旨在预防溶血性尿毒症综合征（HUS）。
针对大肠杆菌O157住院患者中HUS发生情况的非随机前瞻性研究。
收治292名住院患者的医院。
共有292名6至11岁感染大肠杆菌O157的住院患者，其中36例（12.3%）为HUS病例。
大多数HUS住院患者（91.7%）在发病后第6至9天出现该并发症。因此，我们分析了抗菌治疗，尤其是磷霉素治疗，在发病后前5天对预防HUS的效果，因为磷霉素是最常用的药物（88.0%）。为阐明单独使用磷霉素对预防HUS的效果，我们使用了130名在发病后前5天单独接受磷霉素治疗或未接受任何抗菌药物治疗的住院患者的数据进行分析。多因素分析在控制年龄、性别和发热情况后显示，发病后前3天使用磷霉素发生HUS的所有调整比值比均小于1.0，在发病后第2天使用磷霉素具有统计学意义（调整后的OR，0.09；95%CI，0.01 - 0.79）。此外，在发病后前两天使用磷霉素的住院患者发生HUS的频率明显低于未使用的患者（调整后的OR，0.15；95%CI，0.03 - 0.78）。另一方面，发病后第3天及以后使用磷霉素治疗与预防HUS无关。
发病后前两天早期使用磷霉素可能预防HUS的发生。
