基层医院儿童抗生素相关性腹泻影响因素及肠道感染菌群特征性研究

Influential factors of antibiotic-associated diarrhea in children in primary hospitals and characteristics of intestinal infections

目的:摘要目的:探析儿童抗生素相关性腹泻的影响因素以及肠道感染菌群特征。方法:纳入2018年6月-2019年3月在入住我科的患儿93例,患者在住院期间均使用过抗生素,根据使用后是否出现抗生素相关性腹泻,分为AAD组和非AAD组,比较组间差异。另选择86例正常健康的儿童作为对照组,男童56例,女童30例,年龄2~12岁。观察和比较发生AAD的患儿与正常儿童的肠道菌群差异。采用多因素Logistic回归分析影响儿童相关性腹泻的影响因素。结果:AAD患儿肠道内细菌总数较少,且革兰氏阴性菌增多,革兰氏阳性杆菌相比正常值减少。双歧杆菌等益生菌数量明显减少。B/E均小于10,肠道内菌群均属于失调状态。菌群失调程度为Ⅰ度肠道菌群失调的20人,占比37.74%,Ⅱ度肠道菌群失调32人,占比60.38%,Ⅲ度肠道菌群失调仅1人,占比1.89%。多因素logistic回归分析显示儿童的年龄(OR=1.861,95%CI:1.803-1.920)、使用抗生素的时间长(OR=1.522,95%CI:1.501-1.543)、使用种类多(OR=2.077,95%CI:2.009-2.148)、使用青霉素和头孢类抗生素(OR=2.751,95%CI:2.735-2.767)以及营养不良(OR=1.699,95%CI:1.621-1.781)是患抗生素相关性腹泻的危险因素。结论:患有抗生素相关性腹泻的儿童肠道内双歧杆菌等益生菌减少,革兰氏阴性菌增加,双歧杆菌/大肠杆菌<10,有不同程度的肠道菌群失调。儿童的年龄、使用抗生素的时间长、使用种类多、使用青霉素和头孢类抗生素以及营养不良是患抗生素相关性腹泻的危险因素。在临床治疗中应谨慎使用抗生素,减少AAD的出现。

Objective:To analyze the influencing factors of antibiotic-associated diarrhea in children and the characteristics of intestinal infections.Methods:Ninety-three children admitted to our department from June 20 to March 2019 were enrolled.All patients used antibiotics during hospitalization.They were divided into AAD group and non-AAD group according to whether antibiotic-related diarrhea occurred after use.Compare differences between groups.Another 86 normal healthy children were selected as the control group,56 boys and 30 girls,aged 2-12 years.Observe and compare the difference in intestinal flora between children with AAD and normal children.Multivariate logistic regression was used to analyze the influencing factors affecting children’s related diarrhea.Results:The total number of bacteria in the intestinal tract of children with AAD was small,and Gram-negative bacteria increased,and Gram-positive bacilli decreased compared with normal values.The number of probiotics such as bifidobacteriais significantly reduced.B/E is less than 10,and the intestinal flora is in an unbalanced state.The degree of dysbacteriosis was 20 in the intestinal flora of I degree,accounting for 37.74%,32 in the second degree intestinal flora,accounting for 60.38%,and only one in the third degree intestinal flora,accounting for 1.89.%.Multivariate logistic regression analysis showed that children’s age(OR=1.861,95%CI:1.803-1.920),long time to use antibiotics(OR=1.522,95%CI:1.501-1.543),and many types of use(OR=2.077,95%CI:2.09-2.148),use of penicillin and cephalosporin antibiotics(OR=2.751,95%CI:2.735-2.767)and malnutrition(OR=1.699,95%CI:1.621-1.781)are antibiotic-associated diarrhea The risk factor.Conclusion:Probiotics such as bifidobacteria in the intestine of children with antibiotic-associated diarrhea are reduced,Gram-negative bacteria are increased,and Bifidobacterium/E.coli is<10,with varying degrees of intestinal flora imbalance.The age of children,the length of antibiotic use,the variety of uses,the use of penicillin and cephalosporin antibiotics,and malnutrition are risk factors for antibiotic-associated diarrhea.Antibiotics should be used with caution in clinical treatment to reduce the presence of AAD.