Wong C S, Jelacic S, Habeeb R L, Watkins S L, Tarr P I
Children's Hospital and Regional Medical Center and the University of Washington School of Medicine, Seattle 98105, USA.
N Engl J Med. 2000 Jun 29;342(26):1930-6. doi: 10.1056/NEJM200006293422601.
Children with gastrointestinal infections caused by Escherichia coli O157:H7 are at risk for the hemolytic-uremic syndrome. Whether antibiotics alter this risk is unknown.
We conducted a prospective cohort study of 71 children younger than 10 years of age who had diarrhea caused by E. coli O157:H7 to assess whether antibiotic treatment in these children affects the risk of the hemolytic-uremic syndrome and to assess the influence of confounding factors on this outcome. Estimates of relative risks were adjusted for possible confounding effects with the use of logistic-regression analysis.
Among the 71 children, 9 (13 percent) received antibiotics and the hemolytic-uremic syndrome developed in 10 (14 percent). Five of these 10 children had received antibiotics. Factors significantly associated with the hemolytic-uremic syndrome were a higher initial white-cell count (relative risk, 1.3; 95 percent confidence interval, 1.1 to 1.5), evaluation with stool culture soon after the onset of illness (relative risk, 0.3; 95 percent confidence interval, 0.2 to 0.8), and treatment with antibiotics (relative risk, 14.3; 95 percent confidence interval, 2.9 to 70.7). The clinical and laboratory characteristics of the 9 children who received antibiotics and the 62 who did not receive antibiotics were similar. In a multivariate analysis that was adjusted for the initial white-cell count and the day of illness on which stool was obtained for culture, antibiotic administration remained a risk factor for the development of the hemolytic uremic syndrome (relative risk, 17.3; 95 percent confidence interval, 2.2 to 137).
Antibiotic treatment of children with E. coli O157:H7 infection increases the risk of the hemolytic-uremic syndrome.
感染产志贺毒素大肠杆菌O157:H7的儿童有患溶血尿毒综合征的风险。抗生素是否会改变这种风险尚不清楚。
我们对71名10岁以下因O157:H7大肠杆菌感染而腹泻的儿童进行了一项前瞻性队列研究，以评估这些儿童接受抗生素治疗是否会影响患溶血尿毒综合征的风险，并评估混杂因素对这一结果的影响。使用逻辑回归分析对相对风险估计值进行调整，以消除可能的混杂效应。
在这71名儿童中，9名（13%）接受了抗生素治疗，10名（14%）患上了溶血尿毒综合征。这10名儿童中有5名接受了抗生素治疗。与溶血尿毒综合征显著相关的因素包括初始白细胞计数较高（相对风险为1.3；95%置信区间为1.1至1.5）、发病后不久进行粪便培养评估（相对风险为0.3；95%置信区间为0.2至0.8）以及接受抗生素治疗（相对风险为14.3；95%置信区间为2.9至70.7）。接受抗生素治疗的9名儿童和未接受抗生素治疗的62名儿童的临床和实验室特征相似。在对初始白细胞计数和进行粪便培养的发病天数进行调整的多变量分析中，使用抗生素仍然是发生溶血尿毒综合征的一个风险因素（相对风险为17.3；95%置信区间为2.2至137）。
对感染O157:H7大肠杆菌的儿童使用抗生素治疗会增加患溶血尿毒综合征的风险。
