根据β-内酰胺酶选择抗生素对降低细菌性重症肺炎患儿抗生素相关性腹泻发生率的作用

Effect of β-lactamase detection on reducing the incidence of antibiotic-associated diarrhea in children with severe bacterial pneumonia

摘要:

目的 探讨根据细菌β-内酰胺酶（BLs）选用β-内酰胺/β-内酰胺酶抑制剂（BL/BLI）对细菌性重症肺炎抗生素相关性腹泻（AAD）发生率的影响。方法 回顾性分析细菌性重症肺炎患儿临床资料，将未行BLs 检测、经验性选用阿莫西林/克拉维酸的248 例患儿及根据BLs 选用阿莫西林或阿莫西林/克拉维酸的323 例患儿作为阿莫西林组；将未检测BLs 直接选用哌拉西林/他唑巴坦的208 例患儿与根据BLs 选用哌拉西林或哌拉西林/他唑巴坦的291 例患儿作为哌拉西林组；将未检测BLs 而直接选用头孢哌酮/舒巴坦的191 例患儿及根据BLs 选用头孢哌酮或头孢哌酮/舒巴坦的341 例患儿作为头孢哌酮组，监测各组患儿的AAD 发生率，分析是否根据BLs 选用BL/BLI 的重症肺炎患儿AAD 发生率和临床症状差异。结果 各组未检测 BLs 直接选用BL/BLI 患儿的AAD 发生率均高于根据BLs 选用BL（BLs 阴性）或BL/BLI（BLs 阳性）患儿的AAD 发生率，P < 0.01。根据BLs 选用BL/BLI 患儿的AAD 病程、抗生素使用时间和住院日均短于未检测BLs 患儿者（P < 0.01）。结论 根据BLs 选用BL/BLI 对降低细菌性重症肺炎患儿AAD 发生率和减轻症状有重要作用。

Abstract:

Objective To study the effect of β-lactamase (BLs) detection and β-lactam/β-lactamase inhibitor (BL/BLI) on the incidence of antibiotic-associated diarrhea (AAD) in children with severe bacterial pneumonia. Methods The clinical data of the children with bacterial severe pneumonia were retrospectively studied. Of all the patients, 248 using amoxicillin/clavulanate but without BLs detection and 323 using amoxicillin (BLs negative) or amoxicillin/clavulanate (BLs positive) were used as the amoxicillin group; 208 patients using piperacillin/tazobactam but without BLs detection and 291 patients using piperacillin (BLs negative) or piperacillin/tazobactam (BLs positive) were used as the piperacillin group; and 191 patients using cefoperazone/sulbactam but without BLs detection and 341 patients using cefoperazone (BLs negative) or cefoperazone/sulbactam (BLs positive) were used as the cefoperazone group. The incidence and clinical symptoms of AAD between the undetected and detected BLs patients were compared. Results The incidences of AAD in the amoxicillin, piperacillin and cefoperazone groups without BLs detection groups were significantly higher than those in the corresponding groups with negative or positive results of BLs detection (P < 0.01). The durations of diarrhea, antibiotic use and hospitalization stay in AAD patients receiving BLs detection were shorter than in those without receiving BLs detection (P < 0.01). Conclusions It is very important to detect BLs for reducing the incidence and relieving symptoms of AAD in children with severe bacterial pneumonia.