重症细菌性感染患儿继发抗生素相关性腹泻的临床分析  

Clinical analysis of secondary antibiotic-associated diarrhea in children with severe bacterial infection

作　　者：王琦婧[1] 俞栋 尹惠梅 杨琳 葛萍萍 WANG Qi- jing;YU Dong;YIN Hui-mei;YANG Lin;GE Ping-ping(Affiliated Hospital of Hangzhou Normal University , Hangzhou , Zhejiang 310000, China)

机构地区：[1]杭州师范大学附属医院儿科,浙江杭州310000

出　　处：《中华医院感染学杂志》2019年第8期1214-1217,共4页Chinese Journal of Nosocomiology

基　　金：浙江省大学生科技创新活动计划暨新苗人才计划基金资助项目(2018R413062)

摘　　要：目的探讨儿内科重症细菌性感染患儿继发抗生素相关性腹泻。方法选择2017年1月-12月在儿内科治疗的重症细菌感染患儿1 342例为研究对象。统计抗生素相关性腹泻(antibiotic-associated diarrhea,AAD)发生率,检测粪便病原菌。比较AAD患儿与非AAD患儿年龄、住院时间、抗菌药物使用时间、白细胞计数、hs-CRP等一般资料,采用多因素Logistic回归分析AAD发生的影响因素。结果重症细菌感染患儿1 342例中有78例患儿确诊为AAD,发生率5.8%;所有患儿均未检测出志贺菌、沙门氏菌、EPEC、EIEC、ETEC、EHEC病菌,病原菌以白假丝酵母检出为主,占46.2%,其次为大肠埃希菌占39.7%,难辨梭状芽孢杆菌(CD)检出率为17.9%;多因素分析结果显示,年龄小、应用抗菌药物≥2种,应用3代头孢菌素、白细胞计数高、hs-CRP高、合并重要脏器损害、抗菌药物应用时间长、住院时间长是继发AAD的高危因素(P<0.05),预防用微生态制剂是保护因素(OR=0.631,P<0.05)。结论儿内科重症细菌性感染患儿继发AAD病原菌复杂,影响因素较多,临床上应注意预防。OBJECTIVE To analyze secondary antibiotic-associated diarrhea (AAD) in children with severe bacterial infection in pediatrics. METHODS A total of 1342 children with severe bacterial infections treated in pediatrics from Jan. to Dec. 2017 were selected as the research subjects. The incidence of AAD was measured and the pathogens in feces were detected. Age, hospitalization time, antimicrobial use time, white blood cell count, hs-CRP of children with AAD and non-AAD were compared, and multivariate analysis of the factors affecting the occurrence of AAD was conducted. RESULTS 78 cases were diagnosed as AAD among the 1342 children, and the incidence was 5.8%. No Shigella , Salmonella , EPEC, EIEC, ETEC, EHEC bacteria were detected in all children. The positive rate of Candida albicans was the highest, followed by Escherichia coli, and the detection rate of CD was 17.9%. Multivariate analysis showed that age, use of more than 2 kinds of antibiotics, application of the 3rd generation cephalosporins, high white blood cell count, high hs-CRP, complication with damage of important organs, long antibiotics application time and long hospital stay were risk factors of secondary antibiotic-associated diarrhea (P<0.05);Preventive use of microecological agents was a protective factor (OR = 0.631.P<0.05). CONCLUSION The pathogens of antibiotic-associated diarrhea in children with severe bacterial infections are complex and have many influencing factors. Wc should pay attention to the prevention of AAD in clinical practice.

关 键 词：儿内科 重症细菌性感染 继发抗生素相关性腹泻 难辨梭状芽孢杆菌 

分 类 号：R725.7[医药卫生—儿科]