[儿童抗生素相关性腹泻中艰难梭菌相关性腹泻的分析]

[Analysis of Clostridium difficile associated diarrhea in pediatric patients with antibiotic-associated diarrhea].

作者信息

Cheng Guoping, Li Zihua, Dai Xin, Wang Zaihua, Cai Ping, Chen Li, Zhang Zhen

出版信息

Zhonghua Er Ke Za Zhi. 2015 Mar;53(3):220-4.

DOI:

PMID:26165021

Abstract

OBJECTIVE

To analyze the incidence and treatment of Clostridium difficile infection (CDI) in pediatric patients with antibiotic-associated diarrhea (AAD).

METHOD

Clinical data of totally 577 pediatric patients with AAD seen from January 2012 to January 2014 were collected; those children were divided according to age into 4 groups, 0.25 -1 year, >1 -4 years, >4 -12 years and >12 -18 years old groups, and 220 healthy children were enrolled as controls. CDI was tested by C. Diff Quik Chek Complete (QCC) and BD GeneOhm™ C. Diff Assay (BD-PCR) in all children, and the CDI incidence of four groups was added up. All pediatric patients with AAD were divided into mild, general and severe type according to different symptoms of diarrhea, and grading treatment, the general type and severe type of CDI children were treated with metronidazole and (or) vancomycin, afterwards, the results of grading treatment were analyzed.

RESULT

The number of pediatric patients with AAD were 178, 177, 132 and 90 in 0. 25 - 1 year, > 1 -4 years, > 4 - 12 years and > 12 - 18 years old group, respectively. The positive rate of CDI (22. 0% (39/177)) in > 1 -4 years old AAD patients was very significantly higher compared to the controls (4% (4/91), P < 0. 001), the rate of CDI (21. 2% (28/132)) in > 4 - 12 years old AAD pediatric patients was significantly higher compared to the controls (4% (2/53), P = 0. 004), the rates of CDI in 0. 25 - 1 year and > 12 - 18years old AAD groups were not significantly different from that of the controls (P >0. 05). There were 285 mild type AAD children (no CDI children), 176 general type AAD children (including 47 CDI children), and 116 severe type AAD children (including 81 CDI children). After grading and symptomatic treatment, there were 16 recurrent diarrhea in 128 CDI patients (severe type AAD), and the rest recovered. Two cases were transferred for referral treatment, 2 cases died, and the rest 12 recurrent diarrhea children fully recovered after administration of metronidazole, vancomycin, probiotics and symptomatic treatment.

CONCLUSION

The > 1 -12 years old AAD children had higher CDI rate than healthy children; administration of metronidazole and (or) vancomycin was effective for CD infection.

摘要

目的

分析抗生素相关性腹泻（AAD）患儿艰难梭菌感染（CDI）的发生率及治疗情况。

方法

收集2012年1月至2014年1月期间共577例AAD患儿的临床资料；这些患儿按年龄分为4组，即0.25 - 1岁、>1 - 4岁、>4 - 12岁和>12 - 18岁组，并纳入220例健康儿童作为对照。所有儿童均采用艰难梭菌快速检测试剂盒（QCC）和BD GeneOhm™艰难梭菌检测法（BD-PCR）检测CDI，计算4组的CDI发生率。所有AAD患儿根据腹泻症状不同分为轻型、普通型和重型，进行分级治疗，对普通型和重型CDI患儿采用甲硝唑和（或）万古霉素治疗，之后分析分级治疗结果。

结果

0.25 - 1岁、>1 - 4岁、>4 - 12岁和>12 - 18岁组的AAD患儿分别有178例、177例、132例和90例。>1 - 4岁AAD患儿的CDI阳性率（22.0%（39/177））显著高于对照组（4%（4/91），P < 0.001），>4 - 12岁AAD患儿的CDI发生率（21.2%（28/132））显著高于对照组（4%（2/53），P = 0.004），0.25 - 1岁和>12 - 18岁AAD组的CDI发生率与对照组无显著差异（P > 0.05）。有285例轻型AAD患儿（无CDI患儿），176例普通型AAD患儿（包括47例CDI患儿），116例重型AAD患儿（包括81例CDI患儿）。分级对症治疗后，128例CDI患者（重型AAD）中有16例出现反复腹泻，其余恢复。2例转院治疗，2例死亡，其余12例反复腹泻患儿经甲硝唑、万古霉素、益生菌及对症治疗后完全康复。