儿童炎症性肠病艰难梭菌感染及其易感因素分析

Clostridium difficile infection and its susceptibility factors in children with inflammatory bowel disease

目的了解儿童炎症性肠病(inflammatory bowel disease,IBD)中艰难梭菌定植及感染的发生率,评估儿童IBD患者发生艰难梭菌感染(Clostridium difficile infection,CDI)的易感因素。方法选取62例确诊IBD患儿为IBD组,选择同期因迁延性或慢性腹泻就诊并排除IBD的儿童42例为非IBD组,比较两组CDI情况;根据是否合并CDI将IBD组分为IBD合并CDI组(n=12)和IBD无CDI组(n=50),收集两组患儿相关临床资料行CDI易感因素分析。结果IBD组CDI发生率为19%(12/62),高于非IBD组(2%,1/42)(P<0.05)。IBD合并CDI组病程长于IBD无CDI组(P<0.05),发热、腹泻、腹痛比例高于IBD无CDI组(P<0.05)。IBD合并CDI组儿童克罗恩病活动指数、C反应蛋白、红细胞沉降率高于IBD无CDI组(P<0.05)。单因素分析显示,IBD合并CDI组疾病严重程度(中重度)、使用激素、诊断前接受广谱抗生素治疗14 d以上比例高于IBD无CDI组(P<0.05)。结论IBD患儿CDI发生率较非IBD儿童高。病情越严重、使用广谱抗生素及激素可能导致IBD患儿更易发生CDI。

Objective To investigate the incidence rates of Clostridium difficile colonization and Clostridium difficile infection(CDI)in children with inflammatory bowel disease(IBD)and the susceptibility factors for CDI in children with IBD.Methods A total of 62 children diagnosed with IBD were enrolled as the IBD group.Forty-two children who attended the hospital due to persistent or chronic diarrhea and were excluded from IBD were enrolled as the non-IBD group.The incidence rate of CDI was compared between the two groups.According to the presence or absence of CDI,the IBD group was subdivided into two groups:IBD+CDI(n=12)and non-CDI IBD(n=50),and the clinical data were collected from the two groups to analyze the susceptibility factors for CDI.Results The IBD group had a significantly higher incidence rate of CDI[19%(12/62)vs 2%(1/42);P<0.05]than the non-IBD group(P<0.05).Compared with the non-CDI IBD group,the IBD+CDI group had a significantly longer disease course(P<0.05),and a significantly higher proportion of children with fever,diarrhea,or abdominal pain(P<0.05).The IBD+CDI group had significantly higher activity indices of pediatric Crohn’s disease,C-reactive protein levels and erythrocyte sedimentation rate than the non-CDI IBD group(P<0.05).The univariate analysis showed that compared with the non-CDI IBD group,the IBD+CDI group had a significantly higher proportion of children with moderate-to-severe disease,use of glucocorticoids,or treatment with broad-spectrum antibiotics for more than 14 days before diagnosis(P<0.05).Conclusions The children with IBD have a higher incidence of CDI than those without IBD.Severe disease conditions and use of broad-spectrum antibiotics or glucocorticoids may be associated with an increased incidence of CDI in children with IBD.