Versloot Christian J, Attia Suzanna, Bourdon Céline, Richardson Susan E, Potani Isabel, Bandsma Robert H J, Voskuijl Wieger
Physiology and Experimental Medicine, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada; University of Groningen, University Medical Center Groningen, Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Groningen, The Netherlands.
Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada.
Clin Nutr ESPEN. 2018 Apr;24:109-113. doi: 10.1016/j.clnesp.2018.01.004. Epub 2018 Feb 1.
BACKGROUND & AIMS: Children with Severe Acute Malnutrition (SAM) often suffer from diarrhea, which is associated with increased mortality. The contribution of intestinal bacteria, parasites and viruses to morbidity such as diarrhea in SAM remains poorly understood. To evaluate their association with clinical outcomes, we detected stool pathogens in children with SAM at hospital admission and after clinical stabilization prior to discharge.
15 intestinal pathogens, fecal calprotectin and C-reactive protein (CRP) were determined at admission and after clinical stabilization in children aged 8-59 months (n = 47) hospitalized in Malawi for complicated SAM. Differences in fecal pathogens, intestinal and systemic inflammation, and clinical outcomes between time points were evaluated using the Wilcoxon Signed-Rank test or Wilcoxon rank-sum test.
On admission pathogens were present in nearly all children and after clinical stabilization many were cleared with only 55% of children still harboring a pathogen (89% vs. 55%, p = 0.001). Nosocomial infections were infrequent. The pathogens Giardia lamblia and Shigella spp. were most likely to persist. After clinical stabilization, fecal calprotectin was higher in children harboring a pathogen (median (IQR): 383 mg/kg (903-149 mg/kg) vs 140 mg/kg (300-71 mg/kg), p = 0.03). CRP did not correlate with fecal calprotectin levels nor was it associated with pathogen detection. Presence of stool pathogens was not associated with clinical outcomes such as diarrhea.
Fecal pathogens were very common and cleared in most children with complicated SAM treated with antibiotics. The presence of stool pathogens after stabilization was associated with increased intestinal inflammation but not with clinical outcomes. (http://www.isrctn.com/ISRCTN13916953).
重度急性营养不良（SAM）患儿常患腹泻，这与死亡率增加有关。肠道细菌、寄生虫和病毒对SAM患儿腹泻等疾病的影响仍知之甚少。为评估它们与临床结局的关联，我们在住院时及出院前临床稳定后检测了SAM患儿的粪便病原体。
对在马拉维住院治疗复杂SAM的8至59个月大儿童（n = 47），在入院时及临床稳定后测定了15种肠道病原体、粪便钙卫蛋白和C反应蛋白（CRP）。使用Wilcoxon符号秩和检验或Wilcoxon秩和检验评估不同时间点粪便病原体、肠道和全身炎症以及临床结局的差异。
入院时几乎所有儿童都有病原体，临床稳定后许多病原体被清除，只有55%的儿童仍携带病原体（89%对55%；p = 0.001）。医院感染很少见。病原体蓝氏贾第鞭毛虫和志贺菌属最有可能持续存在。临床稳定后，携带病原体的儿童粪便钙卫蛋白水平较高（中位数（IQR）：383 mg/kg（903 - 149 mg/kg）对140 mg/kg（300 - 71 mg/kg）；p = 0.03）。CRP与粪便钙卫蛋白水平无关，也与病原体检测无关。粪便病原体的存在与腹泻等临床结局无关。
粪便病原体非常常见，在大多数接受抗生素治疗的复杂SAM患儿中被清除。稳定后粪便病原体的存在与肠道炎症增加有关，但与临床结局无关。（http://www.isrctn.com/ISRCTN13916953）
