Bae Joon Yeol, Lee Dong Hyuk, Ko Kyung Ok, Lim Jae Woo, Cheon Eun Jeong, Song Young Hwa, Yoon Jung Min
Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea.
Korean J Pediatr. 2018 Mar;61(3):84-89. doi: 10.3345/kjp.2018.61.3.84. Epub 2018 Feb 28.
Timely antibiotic therapy in selected cases of diarrhea associated with bacterial infections can reduce the duration and severity of illness and prevent complications. The availability of a predictive index before identification of causative bacteria would aid in the choice of a therapeutic agent.
The study included patients admitted to the pediatrics unit at Konyang University Hospital for acute inflammatory diarrhea from August 1, 2015 to July 31, 2016 who underwent multiplex polymerase chain reaction testing. Of 248 patients, 83 had positive results. The clinical symptoms and blood test results were examined in 61 patients with spp. (25 patients), spp. (18 patients), and (18 patients) infections. The mean age of the 61 patients (male:femal=31:30) was 84.0±54.8 months, and the mean hospital stay was 4.6±1.7 days.
There were no statistical differences in sex, age, clinical symptoms, or signs. Patients with infection were significantly older (=0.00). C-reactive protein (CRP) levels in patients with infection were higher than those in the other 2 groups, at 9.6±6.1 mg/dL. The results of receiver-operating characteristic curve analysis showed that the cutoff age was ≥103.5 months (sensitivity, 72%; specificity, 86%) and the CRP cutoff level was ≥4.55 mg/dL (sensitivity, 80%; specificity, 69%).
Age (≥103.5 months) and higher CRP level (≥4.55 mg/dL) were good predictors of enterocolitis. If neither criterion was met, enterocolitis was unlikely (negative predictive value 97.2%). When both criteria were met, enterocolitis was highly likely.
在某些与细菌感染相关的腹泻病例中,及时使用抗生素治疗可缩短病程、减轻病情严重程度并预防并发症。在确定致病菌之前,若能有一个预测指标,将有助于治疗药物的选择。
该研究纳入了2015年8月1日至2016年7月31日期间因急性炎症性腹泻入住韩国公州大学医院儿科病房且接受多重聚合酶链反应检测的患者。248例患者中,83例检测结果呈阳性。对61例感染特定菌种(某菌种25例、另一菌种18例、又一菌种18例)的患者的临床症状和血液检测结果进行了检查。这61例患者(男∶女 = 31∶30)的平均年龄为84.0±54.8个月,平均住院天数为4.6±1.7天。
在性别、年龄、临床症状或体征方面无统计学差异。感染特定菌种的患者年龄显著更大(P = 0.00)。感染该菌种患者的C反应蛋白(CRP)水平高于其他两组,为9.6±6.1mg/dL。受试者工作特征曲线分析结果显示,截断年龄为≥103.5个月(敏感性72%;特异性86%),CRP截断水平为≥4.55mg/dL(敏感性80%;特异性69%)。
年龄(≥103.5个月)和较高的CRP水平(≥4.55mg/dL)是某小肠结肠炎的良好预测指标。若这两个标准均未满足,则患该小肠结肠炎的可能性不大(阴性预测值97.2%)。当两个标准都满足时,则极有可能患该小肠结肠炎。