Shanghai Jiao Tong University, School of Medicine, Shanghai Children's Hospital, Department of Gastroenterology, Hepatology and Nutrition, Shanghai, China.
Shanghai Jiao Tong University, School of Medicine, Institute of Pediatric Infection, Immunity and Critical Care Medicine, Shanghai, China.
Braz J Infect Dis. 2022 Jul-Aug;26(4):102380. doi: 10.1016/j.bjid.2022.102380. Epub 2022 Jun 23.
Clostridiodes difficile infection (CDI) is one of the most common causes of antibiotic-associated diarrhea in children. Conventional antibiotics and emerging fecal microbiota transplantation (FMT) are used to treat CDI.
Children with CDI admitted to the Shanghai Children's Hospital, from September 2014 to September 2020, were retrospectively included to this observational study. Pediatric patients were assigned as initial CDI and recurrent CDI (RCDI), and symptoms, comorbidities, imaging findings, laboratory tests, and treatments were systematically recorded and analyzed.
Of 109 pediatric patients with CDI, 58 were boys (53.2%), and the median age was 5 years (range, 2-9 years). The main clinical symptoms of CDI children were diarrhea (109/109, 100%), hematochezia (55/109, 50.46%), abdominal pain (40/109, 36.70%); fever, pseudomembrane, vomit, and bloating were observed in 39 (35.78%), 33 (30.28%), and 24 (22.02%) patients, respectively. For the primary therapy with conventional antibiotics, 68 patients received metronidazole, and 41 patients received vancomycin. RCDI occurred in 48.53% (33/68) of those initially treated with metronidazole compared with 46.33% (19/41) of those initially treated with vancomycin (p=0.825). The total resolution rate of FMT for RCDI children was significantly higher than with vancomycin treatment (28/29, 96.55% vs 11/23, 47.83%, p < 0.001). There were no serious adverse events (SAEs) reported after two months of FMT.
The major manifestations of children with CDI were diarrhea, hematochezia, and abdominal pain. The cure rate of FMT for pediatric RCDI is superior to vancomycin treatment.
艰难梭菌感染（CDI）是儿童中最常见的抗生素相关性腹泻的原因之一。传统抗生素和新兴的粪便微生物群移植（FMT）用于治疗 CDI。
本回顾性研究纳入了 2014 年 9 月至 2020 年 9 月期间在上海儿童医学中心住院的 CDI 患儿。儿科患者分为初发 CDI 和复发性 CDI（RCDI），系统记录和分析了症状、合并症、影像学表现、实验室检查和治疗情况。
109 例 CDI 患儿中，男 58 例（53.2%），中位年龄为 5 岁（范围 2-9 岁）。CDI 患儿的主要临床表现为腹泻（109/109，100%）、血便（55/109，50.46%）、腹痛（40/109，36.70%）；发热、假膜、呕吐和腹胀分别见于 39 例（35.78%）、33 例（30.28%）和 24 例（22.02%）患儿。68 例患儿接受甲硝唑治疗，41 例患儿接受万古霉素治疗。接受甲硝唑治疗的患儿中，有 48.53%（33/68）发生 RCDI，而接受万古霉素治疗的患儿中，有 46.33%（19/41）发生 RCDI（p=0.825）。RCDI 患儿接受 FMT 治疗的总缓解率明显高于万古霉素治疗（28/29，96.55% vs 11/23，47.83%，p<0.001）。FMT 治疗后 2 个月内未报告严重不良事件（SAE）。
CDI 患儿的主要表现为腹泻、血便和腹痛。FMT 治疗儿童 RCDI 的治愈率优于万古霉素治疗。
