Clinical Analysis Of Antibiotic Associated Diarrhea In Pediatric Wards

Purpose:By reviewing and analyzing the clinical data of 301 children with antibiotic associated diarrhea(AAD)during hospitalization in the pediatric department of the First Affiliated Hospital of Dali University,we aim to understand the current situation of AAD in children in the northwest region of Yunnan.This study aims to provide some reference for clinical pediatricians in early identification of AAD in children,improving their understanding of AAD in children,and selecting antibiotics reasonably.Methods:Collect the medical history data of the children with AAD diagnosed during the hospitalization in the First Department of Pediatric Medicine of the First Affiliated Hospital of Dali University from September 1,2021 to August 31,2022,and retrospectively analyze the clinical characteristics,laboratory examination results of the children with AAD.Use Microsoft Office Excel to establish a database,and use SPSS 24.0 statistical software to carry out statistical analysis.The counting data is expressed in constituent ratio(%),Measurement data are expressed in(mean±standard deviation)or median,and used for inter-group comparison χ 2.The correlation between the two continuous variables was expressed by Spearman correlation coefficient,with a statistical significance of P<0.05.Results:The incidence of AAD in hospitalized children in our hospital was about 14.6%.The time of admission was spring and winter,accounting for 63.5%of all AAD children’s admission season.There were 215 children with AAD younger than 1 year old,accounting for 71.43%of all children with AAD,while there were 263 children with AAD younger than 3 years old,accounting for 87.38%of all children with AAD.The main reason for admission was 286 cases(95.02%)of respiratory diseases,including 238 cases(79.07%)of pneumonia,Among 301 children with AAD,100(33.2%)had chronic basic diseases,including 41(13.7%)congenital heart disease and 24(8%)hematological malignancies(all acute lymphoblastic leukemia).Cephalosporins(231/301 cases,76.74%)are the main types of antibiotics used by children,of which 203 cases(67.44%)are third-generation cephalosporins,followed by penicillins(53/301 cases,17.61%)and macrolides(50/301 cases,16.61%).The average length of hospitalization is 9.37±5.5 days(4-41 days),and the average duration of antibiotic use is 8.82±4.82 days(3-39 days),of which 93 cases(30.9%)of AAD children with antibiotic use days less than 7 days,208 cases(69.1%)of AAD children with antibiotic use days≥ 7 day.The stool characteristics of children were mainly yellow and soft in 196 cases(65.12%)and thin in 99 cases(32.89%).The average white blood cell count of children was 8.98±4.68 × 10^ 9/L,of which 27 cases(8.97%)had white blood cells less than 4 × 10^ 9/L,180 cases(59.8%)between 4～10 × 10 ^ 9/L,82 cases(27.24%)between 10～20 × 10^ 9/L,and 12 cases(3.99%)more than 20 × 10 ^ 9/L,The average percentage of neutrophils was 34.72±21.89%,the average percentage of lymphocytes was 51.65±20.36%,and the average percentage of monocytes was 9.67±4.71%.However,208 children with AAD were tested for immunoglobulin.The average immunoglobulin IgG was 5.32±2.72g/L,the average immunoglobulin IgA was 0.3 1±0.29g/L,and the average immunoglobulin IgM was 0.6±0.48g/L.In 80 children with AAD,18 cases of Staphylococcus aureus(5.99%),18 cases of Escherichia coli(5.99%),and 15 cases of Klebsiella pneumoniae(4.98%)were the main bacteria in the infection site.In 167 cases,11 cases(6.59%)were cured,134 cases(80.24%)were improved,20 cases(11.98%)were ineffective,and 2 cases(1.19%)were deteriorated after symptomatic treatment with montmorillonite powder,probiotics preparation,racecadotril.The improvement rate of 167 children with AAD treated with probiotics was compared with that of children without probiotics,and the difference was statistically significant(P<0.05),it shows that the use of probiotics is effective in the treatment of AAD.Conclusion:1.People with infants,low immunity,complicated with Chronic basic diseases such as congenital heart disease and acute lymphocytic leukemia,days of antibiotic use ≥7 days,and pathogenic bacteria such as Staphylococcus aureus,Escherichia coli and Klebsiella pneumoniae are prone to AAD;2.The antibiotics liable to cause AAD are mainly the third-generation cephalosporins,penicillin and macrolides,with the highest incidence of cefoperazone and sulbactam;3.The younger the age,the earlier the occurrence of AAD;4.The use of probiotics as an adjunctive treatment for AAD has a good effect;...