儿童艰难梭菌感染临床疗效分析

Clinical Efficacy of Clostridium Difficile Infection in Children

目的分析儿童艰难梭菌感染(clostridium difficile infection,CDI)的临床特征及治疗情况。方法回顾性分析2014年9月~2022年10月于上海交通大学医学院附属儿童医院消化感染科住院收治的159例CDI患儿的临床资料,根据治疗方法的不同将初始CDI患儿分为万古霉素治疗组和甲硝唑治疗组,复发后根据万古霉素或肠菌移植(fecal microbiota transplantation,FMT)治疗将复发性CDI(recurrent CDI,RCDI)患儿分为RCDI万古霉素治疗组和FMT治疗组。结果共纳入159例初发CDI患儿,其中男患儿93例,女患儿66例;患儿年龄为4.3(1.7,8.0)岁。初次发作CDI后,109例(68.55%)患儿经甲硝唑治疗,50例(31.45%)患儿经万古霉素治疗。初次发作CDI患儿经抗生素治疗后共有51例复发,其中甲硝唑治疗组37例,复发率为33.94%,万古霉素治疗组14例,复发率为28.00%,差异无统计学意义(P>0.05)。RCDI患儿中,万古霉素治疗21例,FMT治疗30例,FMT治愈率为90.00%,万古霉素治愈率为57.14%,FMT治愈率明显高于万古霉素。FMT治疗2个月后无严重不良事件报告。结论甲硝唑可作为儿童初始CDI的首选用药,FMT治疗RCDI优于常规抗生素治疗。

Objective To analyze the clinical characteristics and treatment of clostridium difficile infection(CDI)in children.Methods The clinical data of 159 children with CDI admitted to the Department of Gastroenterology and Hepatology,Shanghai Children′s Hospital,School of Medicine,Shanghai Jiao Tong University from September 2014 to October 2022 were retrospectively analyzed.All initial CDI patients were divided into vancomycin treatment group and metronidazole treatment group according to different treatment methods,Children with recurrent CDI(RCDI)were divided into two groups according to vancomycin or FMT treatment.Results A total of 159 children with initial CDI were included,including 93males and 66 females,the age of these children was 4.3(1.7,8.0)years.109 children(68.55%)were treated with metronidazole,and 50 children(31.45%)were treated with vancomycin.Recurrence occurred in 51 children after antibiotic treatment,37 children(33.94%)of them treated with metronidazole,and 14 children(28.00%)of them treated with vancomycin,there was no significant difference(P>0.05).Among RCDI children,21 cases were treated with vancomycin and 30 were treated with FMT.The cure rate of FMT was 90.00%,and the cure rate of vancomycin was 57.14%.The cure rate of FMT was significantly higher than that of vancomycin.There were no serious adverse events reported after two months of FMT treatment.Conclusion Metronidazole can be used as the drug of choice for initial CDI in children.The cure rate of FMT for RCDI is superior to vancomycin treatment.