抗生素可导致儿童艰难梭菌感染率升高

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抗生素可导致儿童艰难梭菌感染率升高

Antibiotics may contribute to high pediatric C. difficile infection rate
来源：爱思唯尔
《儿科》杂志3月3日发表的一项研究显示，近3/4的儿童和青少年艰难梭菌感染属于社区相关性感染，1岁幼儿发病率最高(Pediatrics 2014 March 3 [doi:10.1542/peds.2013-3049])。

该研究纳入了944例小儿患者，包括美国疾病控制预防中心(CDC)新发感染项目2010年在8个州和2011年在10个州确认的885例患儿。其中71%属于社区相关性感染，17%为社区发作医疗机构相关性感染，12%为医疗机构发作性感染。

发病率最高人群为12~23个月婴儿，为66.3例/10万，其次是2~3岁幼儿，发病率为35.7例/10万，4~9岁儿童为15.6例/10万，10~17岁儿童为16.6例/10万。

CDC医学官员Joyanna Wendt博士及其同事报告称：“我们观察到的低龄儿童艰难梭菌发病率高可能与0~2岁儿童门诊抗生素处方率最高有关。”抗生素使用可增加艰难杆菌感染风险，因为这些药物能够改变或杀死可预防感染的有益菌。

在采集便样当天报告腹泻且接受面谈的84例患儿中，73%(61例)报告在腹泻开始前12周内服用了抗生素，耳部、鼻窦和上呼吸道感染是使用抗生素的最常见原因。

CDC主任Tom Frieden博士在声明中指出：“改善抗生素处方规范程度对保护儿童健康至关重要。一旦错误开具抗生素处方，就会使儿童被置于不必要的健康问题风险之中，包括艰难梭菌感染和危险的抗生素耐药感染。”

发病率不受性别影响，不过白人儿童发病率较高，为23.9例/10万儿童，而非白人儿童为17.4例/10万。研究者称：“在某种程度上可能反映了卫生保健可获得性方面的差异。”

该研究由CDC资助，共同作者Dennis N. Gerding博士是默克、Rebiotix、Summit和爱可泰隆公司董事会成员，并担任罗氏、诺华、赛诺菲巴斯特和Cubist公司的顾问，他还是艰难梭菌感染治疗药物万古霉素的生产商ViroPharma的顾问和专利使用许可人。其他作者无利益冲突披露。

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By: TARA HAELLE, Internal Medicine News Digital Network

Nearly three-quarters of Clostridium difficile infections in children and teens were community associated, with the highest incidence among 1-year-olds, according to a study published March 3 in Pediatrics.

The 944 pediatric cases analyzed for the study involved 885 children identified in select counties throughout eight states in 2010 and 10 states in 2011 as part of the Centers for Disease Control and Prevention’s Emerging Infections Program. Among those cases, 71% were community associated, 17% were community onset health care facility–associated and 12% were health care facility–onset (Pediatrics 2014 March 3 [doi:10.1542/peds.2013-3049]).

The highest incidence of 66.3 children/100,000 occurred among those aged 12-23 months old, followed by an incidence of 35.7 in children aged 2-3 years, 15.6 for those aged 4-9 years, and 16.6 for children aged 10-17 years.

"The high C. difficileinfection incidence we observed among the youngest age group may be related to the finding that children 0-2 years of age have the highest outpatient antibiotic prescribing rate," reported Dr. Joyanna Wendt, a medical officer at the CDC, and her colleagues. Antibiotic use increases risk of C. difficileinfection because the medication can change or kill beneficial bacteria that protect against infection.

Among a smaller sample of 84 cases interviewed in the study and reporting diarrhea on the first day of stool collection, 73% (61 cases) reported taking antibiotics within 12 weeks before the diarrhea began. Ear, sinus, and upper respiratory tract infections comprised the most common reasons for antibiotic use.

"Improved antibiotic prescribing is critical to protect the health of our nation’s children," Dr. Tom Frieden, CDC director, said in a prepared statement. "When antibiotics are prescribed incorrectly, our children are needlessly put at risk for health problems, including C. difficile infection and dangerous antibiotic-resistant infections."

Incidence did not differ by sex, but white children had a higher incidence, with 23.9 cases/100,000 children, compared with 17.4 for nonwhite children, "likely reflecting, in part, differences in health care access," the researchers wrote.

This study was supported by the CDC. Coauthor Dr. Dennis N. Gerding is a board member at Merck, Rebiotix, Summit, and Actelion and consults for Roche, Novartis, Sanofi Pasteur, and Cubist; he consults for and holds patents licensed to ViroPharma, which manufactures vancomycin to treat C difficile. No other authors reported disclosures.

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