抗生素相关性腹泻患儿艰难梭菌感染分析

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

目的 探讨抗生素相关性腹泻（AAD）患儿艰难梭菌（CD）感染的阳性率及治疗转归情况.方法 收集2012年1月至2014年1月武汉市妇女儿童医疗保健中心和湖北省通城县人民医院577例AAD患儿的临床资料,按照不同年龄将AAD患儿分为3个月～1岁、＞1 ～4岁、＞4 ～12岁和＞12 ～18岁四组,同时选择220名不同年龄健康儿童作为正常对照组.采用谷氨酸脱氢酶免疫法和PCR二步法检测患儿CD感染,分析不同年龄AAD患儿CD感染的阳性率.将AAD患儿分为轻型、一般型和严重型并给予分级管理治疗,一般型和严重型患儿给予甲硝唑和（或）万古霉素治疗,比较各组转归.结果 577例AAD患儿中3个月～1岁、＞1 ～4岁、＞4 ～ 12岁、＞12 ～ 18岁分别为178例、177例、132例、90例.＞1 ～4岁AAD患儿CD感染阳性率为22.0％ （39/177）,与正常对照组阳性率4％ （4/91）相比差异有统计学意义（P=0.000）;＞4 ～12岁AAD患儿CD感染阳性率为21.2％ （28/132）,与正常对照组阳性率4％（2/53）相比差异有统计学意义（P =0.004）;而3个月～1岁和＞12 ～18岁AAD患儿CD感染阳性率与正常对照组相比差异无统计学意义（P＞0.05）.577例AAD患儿中轻型285例（无CD感染患儿）,一般型176例（CD感染患儿47例）,严重型116例（CD感染患儿81例）.经分级对症治疗后128例CD感染患儿有16例复发腹泻（均为严重型）,其余患儿全部痊愈.16例复发腹泻患儿2例转院,2例死亡,余12例使用甲硝唑、万古霉素、益生菌和其他对症治疗后全部痊愈出院.结论 ＞1 ～12岁AAD患儿CD感染阳性率较高.甲硝唑和（或）万古霉素治疗对CD感染有效.

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 GeneOhmTM 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.