A Clinical Epidemiology Survey And Comprehensive Evaluation Of Probiotics Prevention On Diarrhea Of Infants With Pneumonia

【Objective】To investigate influential factors of secondary diarrhea in infants with pneumonia. To evaluate the efficacy and economic benefits of preventive application of probiotics (Bifico, oral capsules of live combined Bifidobacterium, Lactobacillus and Enterococcus).【Methods】(Part I) The final study cases of 966 infants with pneumonia in our hospital(three-A-level general hospitals in China) were reviewed from Jan.2008 to Sep.2010. The case group were suffered from diarrhea during the hospitalisation and the control group were those who weren't. All met the inclusion criteria: none had diarrhea during the first 3 days in hospital. Nonconditional multiplicity logistic regression model analysis were used to analyze the relationships among the clinical features of infants with pneumonia, the prophylactic use of Bifico and the occur of secondary diarrhea. (Part II) Chi-square test, time-effect analysis by Kaplan-Meier method and multivariate Cox regression analysis were used to assess/analyze the difference of diarrhea duration due to the prophylactic use of probiotics.(Part III) The economical difference between the prevention group(infants with prophylactic use of probiotics) and the control group was analyzed by ?x±s rate, t tests and other assessment in the same period(966 cases).It was to assess the economic benefits caused/ brought by prophylactic probiotics on diarrhea of infants with pneumonia.【Results】(Part I) The total incidence of diarrhea was 26.81%(259/966), and 75.29%(195/259) of those younger than 1 year old. The morbidity was 18.69%(111/594) in the intervention group with prophylactic use of Bifico; and 39.78%(148/372) in the control group prevented without Bifico. Non-conditional multiplicity logistic regression model analysis showed that five risk factors were related. They were young ago(χ2=12.122, P=0.000), long hospitalization days(χ2=10.338, P=0.001), poor nutritional status(χ2=7.179 , P=0.007), overuse of antibiotic after admission(χ2=15.025, P=0.000), and invaded operations in hospital(χ2=21.381, P=0.000). The breastfeeding(χ2=10.444, P=0.001) and the prophylactic use of probiotics(χ2=43.543, P=0.000) were two independent protective factors. (Part II) There were 245 diarrhea cases that were used Bifico during the same period. The intervention group included 111 cases, while the non-intervention group included 134 cases. The diarrhoetic duration lasted for (3.9±0.3)days in the intervention group, and (5.3±0.4) days in the the non-intervention group calculated by Kaplan-Meier method of time-effects. With Log-rank significance test method, the difference was proved to be significant(χ2=9.657, P=0.002). The total effective rate of diarrhea in the two groups were 77.48% and 72.39%, but the difference showed no statistically significance(χ2=0.832, P=0.362) by the chi-square test. Multivariate Cox analysis showed three risk factors, which contained longer hospitalization days before diarrhea, use of hormones and no prophylactic Bifico reduce therapeutic effect of secondary diarrhea. (Part III) The total medical costs were 2812980 yuan in 966 cases. And there were 2911.99 yuan in the average cost of per case. Prevention group and control group of medical costs were (2775.04±1724.21) yuan and (3130.66±1899.8) yuan per patient respectively. So prophylactic use of probiotics Bifico could save 355.62 yuan for each patient directly. the difference was was proved to be significant(t=-2.998,P=0.003). Its benefit-cost ratio was 13.02.【Conclusions】The younger infants, longer hospital duration, poorer nutritional status, used a variety of antibiotics during hospitalization, invaded operations are risk factors of diarrhea in infants with pneumonia; breastfeeding and prophylactic use of probiotics are protective factors. Used of hormones and longer hospital duration before diarrhea are risk factors on the therapeutic effect of secondary diarrhea. Diarrhea of infants with pneumonia causes result in much direct economic losses. Prophylactic Bifico has high price-efficiency and can reduce the incidence of diarrhea secondary to pneumonia, short the hospital course and improve the tatal/overall efficiency of diarrhea treatment, while can significantly shorten the course of the secondary to diarrhea. Thus it can reduce the per medical costs significantly. It has high benefit-cost ratio. In conclusion, prophylactic use of Bifico, has reliable clinical efficacy, high economic and social benefits. It's recommended pediatric medical workers on clinical event.