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ABSTRACT Background: Clostridioides difficile infection (CDI) is a potentially severe disease that can present with refractoriness, recurrence, and evolution to death. In Brazil, the epidemiology of CDI seems to differ from that of the United States and most European countries, with only one ribotype (RT) 027-related case and a high prevalence of RT106. Objective: The aim of this study was to evaluate the outcomes of CDI and its possible association with ribotypes at a university hospital in Brazil. Methods: A total of 65 patients with CDI were included and stool samples were submitted to A/B toxin detection and toxigenic culture, and toxigenic isolates (n=44) were also PCR ribotyped. Results: Patients' median age was 59 (20-87) years and there were 16 (24.6%) deaths. The median Charlson comorbidity index (CCI) was 4 (0-15) and 16.9% of the patients had CCI ≥8. The ATLAS score and non-improvement of diarrhea were related to higher mortality. A longer length of hospitalization was related to the enteral nutrition and use of multiple antibiotics. The period between CDI diagnosis and hospital discharge was longer in those who received new antibiotics after diagnosis, multiple antibiotics, and required intensive care treatment. Recurrence was associated with CCI >7. Twenty ribotypes were identified and RT106 was the most frequently detected strain (43.2%). No relationship was observed between the ribotypes and outcomes. CDI was present in patients with more comorbidities. Conclusion: Risk factors for higher mortality, longer hospital stay and recurrence were identified. A diversity of ribotypes was observed and C. difficile strains were not related to the outcomes.
RESUMO Contexto: A infecção pelo Clostridioides difficile (ICD) é uma doença potencialmente grave que pode se apresentar com refratariedade, recidiva e evoluir para óbito. No Brasil, a epidemiologia da ICD parece diferir da dos Estados Unidos e da maioria dos países europeus, com apenas um caso relacionado ao ribotipo (RT) 027 e alta prevalência do RT106. Objetivo: Avaliar os desfechos da ICD e sua possível associação com ribotipos em um hospital universitário do Brasil. Métodos: Um total de 65 pacientes com ICD foram incluídos e amostras de fezes foram submetidas à detecção de toxina A/B e cultura toxigênica e as cepas toxigênicas isoladas (n=44) também foram ribotipadas por PCR. Resultados: A idade mediana dos pacientes foi de 59 (20-87) anos e houve 16 (24,6%) óbitos. A mediana do índice de comorbidade de Charlson (ICC) foi de 4 (0-15) e 16,9% dos pacientes apresentaram ICC ≥8. O escore ATLAS e a não melhora da diarreia foram relacionados a maior mortalidade. Maior tempo de internação esteve relacionado à nutrição enteral e ao uso de múltiplos antibióticos. O período entre o diagnóstico de ICD e a alta hospitalar foi maior naqueles que receberam novos antibióticos após o diagnóstico, múltiplos antibióticos e necessitaram de tratamento intensivo. A recorrência foi associada com ICC >7. Vinte ribotipos foram identificados e o RT106 foi a cepa mais frequentemente detectada (43,2%). Não foi observada relação entre os ribotipos e os desfechos. ICD esteve presente em pacientes com mais comorbidades. Conclusão: Foram identificados fatores de risco para maior mortalidade, maior tempo de internação e recorrência. Uma diversidade de ribotipos foi observada e cepas de C. difficile não foram relacionadas aos desfechos.
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Abstract Clostridioides difficile is a spore-forming anaerobe microorganism associated to nosocomial diarrhea. Its virulence is mainly associated with TcdA and TcdB toxins, encoded by their respective tcdA and tcdB genes. These genes are part of the pathogenicity locus (PaLoc). Our aim was to characterize relevant C. difficile toxinotypes circulating in the hospital setting. The tcdA and tcdB genes were amplified and digested with different restriction enzymes: EcoRI for tcdA; HincII and AccI for tcdB. In addition, the presence of the cdtB (binary toxin) gene, TcdA and TcdB toxins by dot blot and the cytotoxic effect of culture supernatants on Vero cells, were evaluated. Altogether, these studies revealed three different circulating toxinotypes according to Rupnik's classification: 0, I and VIII, being the latter the most prevalent one. Even though more studies are certainly necessary (e.g. sequencing analysis), it is worth noting that the occurrence of toxinotype I could be related to the introduction of bacteria from different geographical origins. The multivariate analysis conducted on the laboratory values of individuals infected with the most prevalent toxinotype (VIII) showed that the isolates associated with fatal outcomes (GCD13, GCD14 and GCD22) are located in regions of the biplots related to altered laboratory values at admission. In other patients, although laboratory values at admission were not correlated, levels of urea, creatinine and white blood cells were positively correlated after the infection was diagnosed. Our study reveals the circulation of different toxinotypes of C. difficile strains in this public hospital. The variety of toxinotypes can arise from pre-existing microorganisms as well as through the introduction of bacteria from other geographical regions. The existence of microorganisms with different pathogenic potential is relevant for the control, follow-up, and treatment of the infections.
Resumen Clostridioides difficile es un anaerobio esporulado que se asocia con episodios de diarreas hospitalarias. Su virulencia se encuentra vinculada, principalmente, a las toxinas TcdA y TcdB, codificadas por sus respectivos genes, tcdA y tcdB, que son parte de un locus de patogenicidad (PaLoc). Nuestro objetivo fue caracterizar los toxinotipos de C. difficile circulantes en un hospital público. Los genes tcdA y tcdB fueron amplificados y digeridos con diferentes enzimas de restricción: EcoRI para tcdA; HincII y AccI para tcdB. Además, se evaluó la presencia de cdtB (gen de la toxina binaria B) y de las toxinas A y B (por dot blot), así como el efecto citotóxico de sobrenadantes de cultivo sobre células Vero. En conjunto, estos estudios revelaron tres toxinotipos circulantes según la clasificación de Rupnik: 0, I y VIII; el más prevalente fue el último. Aunque son necesarios más estudios (ej., secuenciación), es interesante notar que la presencia del toxinotipo I podría estar relacionada con la introducción de bacterias de diferente origen geográfico. En los pacientes infectados con el toxinotipo VIII, el análisis multivariante de los resultados de laboratorio mostró que los aislamientos asociados a decesos (GCD13, GCD14 y GCD22) estaban situados en regiones de los biplots relacionados con valores de laboratorio alterados al momento de la internación. En los otros pacientes, aunque no se observó correlación entre los valores de laboratorio al momento de la internación y la evolución clínica, los niveles de urea, creatinina y recuento de glóbulos blancos estuvieron correlacionados positivamente entre sí una vez diagnosticada la infección. Nuestro estudio revela la circulación de diferentes toxinotipos de C. difficile en un mismo hospital público. La variedad de toxinotipos puede originarse a partir de microorganismos preexistentes en la región, así como también por la introducción de bacterias provenientes de otras regiones geográficas. La existencia de microorganismos con diferente potencial patogénico es relevante para el control, el seguimiento y el tratamiento de las infecciones.
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Objective To analyze the epidemiological characteristics and risk factors of antibiotic-associated diarrhea (AAD) in children with pneumonia in Chongzhou, Sichuan Province, and to provide a theoretical basis for the diagnosis and treatment of AAD in children with pneumonia. Methods A total of 394 children with pneumonia admitted to our hospital from June 2018 to June 2021 were selected and divided into control group and AAD group according to whether the children had AAD. Univariate analysis and logistic regression were used to analyze the risk factors of pediatric pneumonia complicated with AAD. Results There were 79 cases of children with pneumonia complicated with AAD (20.05%). The average age of the ADD group was significantly lower than that of the control group (P<0.05). There were significant differences between the two groups in age of onset, length of hospital stay, type of antibiotics combined use, duration of antibiotics application, proportion of bacterial use of probiotics, and type of antibiotics (P<0.05). The age of onset <3 years old, duration of antibiotics application ≥5 days, combined use of three kinds of antibiotics, use of cephalosporin antibiotics, and no use of probiotics are independent risk factors for AAD in children with pneumonia. Conclusion The risk of AAD in children with pneumonia in Chongzhou is high, and the main pathogens are Candida and Escherichia coli. For children with cephalosporin antibiotics use, long application time of antibiotics, and onset age <3 years old, early application of probiotics should be done to reduce the risk of pediatric pneumonia complicated with AAD.
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ObjectiveTo investigate the mechanism of Gegen Qinliantang（GQT） on the intestinal flora of antibiotic-associated diarrhea（AAD） by 16S rRNA sequencing and network pharmacology. MethodSixty SD rats were randomly divided into six groups（n=10）， including blank group， model group， GQT high-， medium- and low-dose groups（10.08， 5.04， 2.52 g·kg-1） as well as Lizhu Changle group（0.15 g·kg-1）， except for the blank group， each group was given clindamycin（250 mg·kg-1） by gavage once a day for 7 consecutive days. After successful modeling， the blank group and the model group were given equal volumes of normal saline by gavage. The other groups were given corresponding doses of drugs by gavage for 14 days. Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform（TCMSP） was used to screen the active components and targets of GQT， GeneCards， Online Mendelian Inheritance in Man（OMIM） database， Pharmacogenetics and Pharmacogenomics Knowledge Base（PharmGKB）， DrugBank and DisGeNET were used to search for AAD disease targets. The drug-disease common targets were obtained by R software. STRING was applied to analyze the target protein-protein interaction， and Kyoto Encyclopedia of Genes and Genomes（KEGG） pathway enrichment analysis was performed. Then hematoxylin-eosin（HE） staining was used to observe the pathological changes of the colon， and 16S rRNA sequencing of AAD colon content flora structure further verified the results of network pharmacology. ResultThrough network pharmacology， it was found that 238 active components were screened from GQT and acted on 276 component targets， among which quercetin， puerarin， wogonin and apigenin were the main core components of GQT， 1 097 AAD disease targets and 127 drug-disease intersection targets. The protein-protein interaction network mainly included core targets such as protein kinase B1（Akt1）， interleukin（IL）-6 and IL-1β， which were mainly enriched in the IL-17 signaling pathway. It was verified through animal experiments that compared with the blank group， the colon structure of the model group was seriously abnormal， the intestinal epithelial columnar cells were damaged， the goblet cells were reduced， and a large number of inflammatory cells were infiltrated. Compared with the model group， the colon structure of the GQT high-dose group improved， but there were still abnormalities， the colon structure of GQT medium- and low- dose groups and Lizhu Changle group improved significantly and reached the normal level. GQT could improve the structural diversity of AAD intestinal flora. At the phylum level， the abundance of Firmicutes was increased and the abundance of Bacteroidetes was decreased. At the genus level， the abundance of Lactobacillus was increased， and the abundances of Prevotella and Bacteroides were decreased. Among them， Lactococcus could be used as a biomarker for AAD treatment with GQT， and the prediction of functional metabolism of intestinal flora revealed that GQT could promote acetate and lactate metabolic pathways in the intestine. ConclusionGQT may activate IL-17 signaling pathway by acting on the targets of Akt1 and IL-6 through key components such as quercetin and wogonin， and improve the abundance of Lactococcus in the intestinal tract as well as acetate and lactate metabolic pathways， so as to play a role in repairing the intestinal barrier for the treatment of AAD.
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@#Clostridiodes difficile(C.difficile)is the most common causative agent of antibiotic-associated diarrhea(ADD)in the world. In recent years,with the emergence of highly resistant and virulent strains,the outbreaks of C.difficile infection have occurred around the world. The incidence,recurrence and mortality of C.difficile infection are on the rise worldwide,and bring great challenges to clinical treatment. Pathogenic strains mainly produce two homologous glycosylation toxins A and B,which can cause symptoms ranging from diarrhea to highly lethal toxic megacolon. In view of the malignant consequences caused by C.difficile infection,disease prevention is still an important way worth exploring. Until now there is no approved vaccine against C.difficile. Therefore,this review assessed the status and challenge of clinical trials of vaccine research for C.difficile.
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This study was aimed to explore the effect of Zingiberis Rhizoma extract on rats with antibiotic-associated diarrhea(AAD), and reveal the modulation of gut microbiota during alleviation of AAD. AAD rat model was successfully established by exposing rats to appropriate antibiotic mixed solution. Peficon(70 mg·kg~(-1)·d~(-1)) was used as positive control, then rats were treated with 200 mg·kg~(-1)·d~(-1) and 400 mg·kg~(-1)·d~(-1) of Zingiberis Rhizoma extract for low and high dosage groups of Zingiberis Rhizoma extract, respectively. The weight changes of the rats were observed, and the degree of diarrhea were evaluated by fecal score, 120 min fecal weight and fecal water content. Colon tissues for histopathological examination were stained with hematoxylin and eosin(HE), and 16 S rRNA sequencing analysis of gut microbiota was performed. The results showed that compared with the model group, the degree of diarrhea, indicated by fecal water content, fecal score, and 120 min fecal weight of positive control group, Zingiberis Rhizoma low-dose group and Zingiberis Rhizoma high-dose group were significantly ameliorated. And the treatment of Zingiberis Rhizoma could significantly improve the pathological condition of colon tissue in AAD rats, especially the high dose of Zingiberis Rhizoma. In addition, 16 S rRNA sequencing analysis of gut microbiota showed that the diversity and abundance of gut microbiota were significantly improved and the reco-very of gut microbiota was accelerated after given high-dose of Zingiberis Rhizoma, while no significant changes of alterations were observed after given Pefikon. Of note, compared with the pefikon group, the abundance and diversity of gut microbiota in Zingi-beris Rhizoma high-dose group were significantly elevated. At the phylum level, the abundance of Firmicutes in AAD rats increased and the abundance of Proteobacteria was decreased after the Zingiberis Rhizoma intervention. At the genus level, the abundance of Bacillus spp., Lachnoclostridium and Escherichia coli-Shigella were decreased, and the abundance of Lactobacillus spp., Trichophyton spp., and Trichophyton spp., etc., were increased. While compared with the AAD model group, there was no significant difference of gut microbiota after given Peficon. The results showed that Zingiberis Rhizoma exerted beneficial health effects against AAD, and positively affected the microbial environment in the gut of rats with AAD.
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Animals , Rats , Anti-Bacterial Agents/adverse effects , Diarrhea/drug therapy , Gastrointestinal Microbiome , Ginger , Plant Extracts , RhizomeABSTRACT
Objective:To explore the microecological mechanisms of Shenling Baizhusan （SLBZ） and Lizhongtang （LZ） in treating antibiotic-associated diarrhea （AAD） based on changes in the diversity of intestinal butyrate-producing bacteria. Method:SD rats were randomly divided into an SLBZ group （5.5 g·kg<sup>-1</sup>·d<sup>-1</sup>） and an LZ group （5.5 g·kg<sup>-1</sup>·d<sup>-1</sup>）. The gut microbiota disturbance model was induced by intragastric administration of clindamycin hydrochloride （315 mg·kg<sup>-1</sup>·d<sup>-1</sup>） and AAD model by <italic>Clostridium difficile</italic>. Subsequently， the rats were treated correspondingly. Fecal samples at different stages were collected and the total DNA was extracted. Polymerase chain reaction （PCR） amplification was performed with the primers of butyryl coenzyme A （CoA）-CoA transferase genes. The PCR products were cloned and sequenced to analyze the diversity response of butyrate-producing bacteria. Result:After treatment， both groups showed increased food uptake， formed feces， glossy and smooth fur， and improved activity and sensitivity. With the butyryl CoA-CoA transferase gene as the molecular marker， 297 sequences of butyrate-producing bacteria in the SLBZ group （SPD for short） and 300 sequences of butyrate-producing bacteria in the LZ group （LPD for short） were obtained. In the SLBZ group， 98， 100， and 99 sequences of SPD were obtained at the normal stage， the modeling stage， and the treatment stage， respectively， belonging to 8， 3， and 6 operational taxonomic units （OTUs）， with similarity ranges of 78%-97%， 86%-99% ， and 81%-97%. The number of OTUs recovered to 75% of the normal level after treatment. In the LZ group， 100 sequences of LPD were obtained at the normal stage， the modeling stage， and the treatment stage， respectively， belonging to 6， 2， and 4 OTUs， with similarity ranges of 83%-97%， 92%-99%， and 85%-99%. The number of OTUs recovered to 80% of the normal level after treatment. Butyrate-producing bacteria were present in all stages of the two groups， dominated by Firmicutes， accounting for more than 98% of the total number. The effects of SLBZ on SPD at the genus level were observed in the significant decrease in <italic>Clostridium</italic> abundance and the significant increase in <italic>Eubacterium</italic> abundance. The effect of LZ on LPD was mainly concentrated on the <italic>Roseburia </italic>at the genus level， and LZ also increased the abundance of <italic>Eubacterium</italic>， <italic>Lacrimi</italic>sp<italic>ora</italic>， and <italic>Clostridium</italic>. According to the phylogenetic tree， the classification of butyrate-producing bacteria increased from five clusters to seven clusters after SLBZ treatment， while that increased from three clusters to nine clusters after LZ treatment. Conclusion:In the treatment of AAD， SLBZ and LZ can regulate the structure and abundance of butyrate-producing bacteria in the intestine， restore their diversity， and improve the instability of the intestinal microecological environment.
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6 years (RR=4.15), with previous abdominal pain (RR=7.2) or constipation (RR=4.06). Constipation was recorded in 23/289 (8.0%), with increased risk in children having surgery (RR=2.56) or previous constipation (RR=7.38). Probiotic supplementation significantly reduced AAD (RR=0.30) and abdominal pain (RR=0.36). Lactobacillus rhamnosus GG (LGG) and L. reuteri significantly reduced AAD (RR=0.37 and 0.35) and abdominal pain (RR=0.37 and 0.24).CONCLUSION: AAD occurred in 20.4% of children, with increased risk at younger age, lower respiratory and urinary tract infections, intravenous treatment and previous AAD. LGG and L. reuteri reduced both AAD and associated abdominal pain.
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Child , Humans , Abdominal Pain , Administration, Intravenous , Anti-Bacterial Agents , Constipation , Diarrhea , Incidence , Inpatients , Limosilactobacillus reuteri , Lacticaseibacillus rhamnosus , Probiotics , Prospective Studies , Protective Factors , Urinary Tract InfectionsABSTRACT
@#The aim of this study was to investigate the effects of co-culture supernatant of Lactobacillus casei(LC)and Bacillus subtiliis natto(BN)on intestinal micro-ecology, mucosal barrier function and immune function in mice with antibiotic-associated diarrhea(AAD). The AAD mouse model was established and the normal saline, LC, BN and co-culture supernatants were administered, respectively, for 4 days. The general conditions of the mice during the intervention were observed. The thymus and spleen weight ratios of different intervention mice were compared. The histopathological changes of the proximal colon lesions were observed. The intestinal microecology, mucosal barrier function and immune function of each group were detected. The results showed that the mice in the model group showed poor mental state, decreased feeding intake and abnormal stool characteristics, which were aggravated with the prolongation of time. After intervention, the above-mentioned states of mice in each group were improved, with the best recovery for the co-culture group. Histopathological results showed that the intestinal wall of the model group was severely damaged and villus was shedding. Cellulose-like exudation, necrosis of epithelial cells and infiltration of inflammatory cells could be seen in the model group. The pathological changes mentioned above were improved after intervention, and the co-culture group had the best effect. Compared with the control group, the thymus and spleen weight ratio, microbial diversity(Shannon)index, richness(Chao)index, Lactobacillus number, Bifidobacterium number, secretory immunoglobulin IgA(sIgA)in intestinal mucosa, interleukin(IL)-2 and IL-2/IL-4, the relative expressions of tight junction related protein-1(ZO-1)and atresia protein(Occludin)in intestinal tissue of the model group were lower, while the number of enterobacteria, enterococcus number, serum diamine oxidase(DAO)bacterial ectopic rate and IL-4 in intestinal tissue were higher(P< 0. 05). Compared with the model group, the thymus, spleen weight ratio, Shannon, Chao index, Lactobacillus number, Bifidobacterium number, sIgA in intestinal mucosa, IL-2 and IL-2/IL-4, the relative expressions of ZO-1 and Occludin in intestinal tissue of the intervention groups were higher(P< 0. 05), and the co-culture group was higher than the LC group and the BN group(P< 0. 05). There was no significant difference between the LC group and the BN group(P> 0. 05). Compared with the model group, the number of enterobacteria, enterococcus, serum DAO, bacterial ectopic rate and intestinal IL-4 in each intervention group were lower(P< 0. 05), and the co-culture group was lower than LC group and BN group(P< 0. 05). There was no significant difference between LC group and BN group(P> 0. 05). There were no significant differences in serum DAO, bacterial ectopic rate, sIgA, IL-2, IL-4 levels and IL-2/IL-4 levels between the co-culture group and the control group(P> 0. 05). The results showed that LC and BN co-culture supernatant can effectively regulate intestinal micro-ecology of AAD mice, improve intestinal mucosal barrier function, and improve intestinal and global immune function.
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To investigate the effect of ginseng neutral polysaccharide on gut microbiota composition and diversity as well as the therapeutic effect for antibiotic associated diarrhea( AAD) in mice. The water-soluble ginseng neutral polysaccharide( WGPN) was purified from water-soluble ginseng polysaccharides( WGP) by DEAE-sepharose fast flow column,which was obtained from the roots of Panax ginseng. AAD mice were induced by gastric gavage with lincomycin hydrochloride,followed by administration of normal saline( natural recovery group,NR) or WGPN( WGPN group) for one week. Body weight changes,psychosis and diarrhea status were observed and assessed. 12 h after the last administration,histological observation of ileum and 16 S rRNA high throughput sequencing analysis of intestinal contents were conducted to identify the effects of WGPN on AAD mice. The results showed that WGPN could alleviate the symptoms of diarrhea in mice,decrease the inflammation and edema of ileum,and increase the length of intestinal villi. As compared to NR mice,WGPN could increase the relative abundance of Lactobacillus,and significantly decrease the relative abundance of Bacteroides,Streptococcus,Ochrobactrum and Pseudomonas at the genus level. In conclusion,WGPN could improve the gut microecology by recovering the ileum structure and improving the diversity and composition of the gut microbiota in AAD mice.
Subject(s)
Animals , Mice , Anti-Bacterial Agents , Diarrhea , Gastrointestinal Microbiome , Panax , PolysaccharidesABSTRACT
Objective:To discussed the clinical efficacy of addition and subtraction therapy of Shenling Baizhu San to antibiotic-associated diarrhea (AAD) with spleen-stomach deficiency and cold syndrome, and to investigate its effects on immune function and intestinal flora. Method:One hundred and fifteen patients were randomly divided into control group (57 cases) and observation group (58 cases) by random number table. Patients in control group got Shuangqi Ganjun Sanlian Huojun San, 2 bags/time, 2 times/days. Mengtuoshi San, 1 bag/time, 3 times/days, and they also got measures to prevent disturbance of water, electrolyte, acid-base balance and nutritional support. Based on the treatment in control group, patients in observation group also got addition and subtraction therapy of Shenling Baizhu San, 1 dose/day. The course of treatment was 7 days in both groups. Before and after treatment, scores of symptoms, intestinal secretory immunoglobulin (SIgA) levels, peripheral blood immunoglobulin A (IgA), G (IgG), M (IgM) and T lymphocyte subsets (CD3+, CD4+, CD8+and CD4+/CD8+). Detection of bacillus faccalis in feces before and after treatment and the bacteria were cultured to identify and count bifidobacterium, lactobacillus and enterococcus. In addition, diamine oxidase (DAO) and D-lactic acid levels were detected before and after treatment. Result:In rank sum test, clinical efficacy in observation group was better than that in control group (Z=2.268, PPP+, CD4+and CD4+/CD8+were higher than those in control group (P+was lower than that in control group (PPPPD-lactic acid were significantly lower than those in control group (PConclusion:Based on conventional treatment, addition and subtraction therapy of Shenling Baizhu San can alleviate symptoms, improve clinical efficacy, improve immune function, regulate intestinal flora and promote the repair of intestinal mucosal barrier in the treatment of antibiotic-associated diarrhea (AAD) with spleen-stomach deficiency and cold syndrome.
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Clostridium difficile (CD),a gram-positive,spore-forming,obligate anaerobic bacillus,is a leading cause of antibiotic-associated diarrhea (AAD) worldwide.With the widespread use of broad-spectrum antibiotics,the incidence of clostridium difficile infection in children is rising,while recurrent clostridium difficile infection (RCDI) requires prolonged treatment and higher medical costs.Malignancy,recent surgery and antibiotic exposures have been identified as the risk factors in children.While the toxigenic strains culture and the cell cytotoxicity neutralization assay are gold standard for the diagnosis,new diagnostic approaches such as nucleic acid amplification method have become available.The use of antibiotics,fecal microbiota transplantation (FMT) or monoclonal antibodies are included in the current treatments for RCDI.This review will cover published studies to discuss the risk factors,diagnosis and treatment of RCDI in children.
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Objective To evaluate the clinical efficacy of Taohua decoction in treating antibiotic-associated diarrhea (AAD). Methods Sixty-two patients diagnosed with AAD admitted to the department of intenive care unit (ICU) of Jiaxing Hospital of Traditional Chinese Medicine (TCM), Jiaxing First Hospital, Jiaxing Second Hospital and Haining Hospital of TCM from April 2015 to November 2016 were enrolled, and they were divided into an experimental group (32 cases) and a control group (30 cases) according to the random number table method. The two groups were given routine treatment of western medicine, the patients in experimental group were additionally given Taohua decoction (ingreients: red halloysite 30 g, zingiberis 15 g, japonica rice 30 g), while in the control group, the patients only received the routine treatment of western medicine. The therapeutic course in the two groups was 14 days. The TCM syndrome score, the duration of diarrhea, the time of abdominal pain relief and the time using antibiotics, besides acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, albumin level, endoscopic and pathological changes were observed before and after treatment in the two groups. Results After treatment, the scores of TCM syndrome and APACHE Ⅱin the two groups were all lower than those before treatment, the level of albumin was higher than that before treatment, and the changes of above indexes in the experimental group were more significant than those in the control group [the scores of TCM syndrome: 9.32±8.86 vs. 13.50±6.52, APACHE Ⅱ score: 11.08±4.37 vs. 14.06±5.42, albumin (g/L): 33.89±5.02 vs. 30.85±6.44, all P < 0.05]; in experimental group, the time of diarrhea duration (days:12.28±2.28 vs. 15.36±8.68), time of abdominal pain relief (days: 10.09±6.41 vs. 14.27±7.52), time of using antibiotics (days: 11.77±4.72 vs. 15.08±6.98) were significantly shorter than those of the control group (all P < 0.05). The examinations of endoscopy and light microscopy showed that after treatment the numbers of patients with mild intestinal mucosal changes in the experimental group were increased compared with those in the control group (endoscope:18 cases vs. 8 cases, light microscopy: 19 cases vs. 9 cases), but the numbers of patients with moderate (endoscope:14 cases vs. 20 cases, light microscopy: 13 cases vs. 19 cases) and severe (endoscope: 0 vs. 2 cases, light microscopy:0 vs.2 cases) changes were less than those in the control group. Conclusions Taohua decoction can improve the clinical efficacy of mild AAD patients.
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OBJECTIVE:To evaluate the risk factors for antibiotic-associated diarrhea (AAD) in Chinese adult patients systematically,and to provide evidence-based reference in clinic. METHODS:Retrieved from CNKI,VIP,CBM,Wanfang database,PubMed and Embase,etc.,disease control studies about AAD risk factors of Chinese adult patients were collected.The retrieval time limit ranged from Jan. 2000 to Jan. 2018. Meta-analysis was performed by using Rev Man 5.2 software after data extraction and quality evaluation of included literatures with NOS scale. RESULTS:A total of 14 literatures were included, involving 20 914 patients. The result of Meta-analysis showed that age ≥65 years [OR＝2.36,95%CI(1.99,2.79),P＜0.001], fasting [OR＝4.65,95%CI(3.79,5.69),P＜0.001],use of acid suppressant [OR＝5.82,95%CI(3.77,8.98),P＜0.001],serum albumin ≤30 g/L [OR＝2.40,95%CI(2.00,2.88),P＜0.001],invasive operation [OR＝3.95,95%CI(3.03,5.15),P＜0.001], stay in ICU [OR＝2.93,95%CI(2.38,3.60),P＜0.001],hospitalization time ≥10 d [OR＝4.08,95%CI(3.31,5.03),P＜0.001], antibiotic species ≥3 kinds [OR＝1.98,95%CI(1.56,2.51),P＜0.001] and duration of antibiotics use ≥10 d [OR＝6.16,95%CI (3.22,11.76),P＜0.001] were significantly correlated with the occurrence of AAD. CONCLUSIONS:Age ≥65 years,fasting, use of acid suppressant,serum albumin ≤30 g/L,invasive operation,stay in ICU,time of hospitalization ≥10 d,antibiotic species≥3 kinds and duration of antibiotics use≥10 d are risk factors for AAD in Chinese adult patients.
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Objective To investigate the clinical usefulness and safety of soluble dietary fiber (SDF) combined with probiotics in treating elderly patients with antibiotic associated diarrhea(AAD).Methods A total of 88 hospitalized elderly patients (≥65 years old) treated with antibiotics during August 2014 to August 2016 were included in this study. Patients were divided into control group(26 cases),probiotics group(30 cases)and combined group(32 cases).The control group was given maltodextrin as placebo intervention, the probiotics group was given the same dose of probiotics only, and the combined group was given SDF and probiotics treatment. The treatment was observed for 14 d. The incidence and the recurrence rate of ADD, the results of fecal culture and the incidence of adverse reactions were monitored in the three groups. Results The incidence of ADD was obviously lower in the combined group and the probiotics group than that of control group(6.25% vs.26.92%,6.67% vs.26.92%,P<0.05).The disease duration of diarrhea was shorter in the combined group than that of probiotic group[(3.53 ± 0.62)d vs.(4.39 ± 1.01)d,P<0.05],but no difference was found when compared with that of control group [(3.55 ± 0.65) d]. After 7-day intervention, Enterococcus counts was significantly deceased in probiotic group(P<0.05).There were no significant changes in Lactobacillus and Bifidobacterium counts in probiotic group after 14-day intervention. In the combined group, after 7-day intervention, Enterococcus counts decreased (P<0.05), and then started increasing until the 14-day(P<0.05).Lactobacillus and Bifidobacterium counts increased with the time passed (P<0.05).The incidence rates of total adverse reactions were 6.25%,10.00% and 23.07% for combined group,probiotics group and control group,and with no significant differences between them.Conclusion The probiotics combined with SDF has a good clinical effect on preventing the occurrence of antibiotic associated diarrhea and shortening the course of diarrhea in the elderly.It has high safety and it can regulate the intestinal flore with high safety.
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Nowadays, Klebsiella oxytoca is described as a causative organism for antibiotic-associated hemorrhagic colitis (AAHC). Here we report two cases of pediatric AAHC, from which K. oxytoca was cultured after starting amoxicillin-clavulanate or amoxicillin treatment. The patients developed severe abdominal pain and a large amount of bloody diarrhea. K. oxytoca was obtained in intestinal fluid culture of a boy through the colonoscopy. On the other hand, colonic tissue culture and intestinal fluid culture were negative of the other patient. K. oxytoca was detected in stool culture when he was admitted. These cases showed characteristic endoscopic findings of segmental hemorrhagic colitis, and both boys recovered spontaneously within 2–3 days after they stopped taking the antibiotics. Therefore, in children who develop relatively large amount of bloody diarrhea after antibiotic treatment, we should consider AAHC caused by K. oxytoca.
Subject(s)
Child , Humans , Male , Abdominal Pain , Amoxicillin , Anti-Bacterial Agents , Colitis , Colon , Colonoscopy , Diarrhea , Hand , Klebsiella oxytoca , KlebsiellaABSTRACT
Objective To study the value of Saccharomyces boulardii for the prevention of antibiotic-associated diarrhea in older inpatients.Methods A total of 163 older patients who were treated with wide-spectrum antibiotics at least three days during January 2014 to December 2015 were randomly divided into control and study group.In study group, 81 patients were administrated with oral Saccharomyces boulardii 500 mg twice a day for 21 days.The control group was of no intervention.Morbidity rate of antibiotic-associated diarrhea and Clostridium difficile-associated diarrhea, frequency and duration of diarrhea were recorded.Results The incidence of antibiotic-associated diarrhea in study group was significantly lower than that in control group [14.8%(12/81) vs 28.0%(23/82), P0.05] in two groups.The frequency and duration of diarrhea in the study group were significantly lower and shorter than those in control group[(4.3±1.7) times/day vs (6.9±2.0) times/day;(3.0±1.1) days vs (5.7±1.8) days, both P<0.01].Conclusion Saccharomyces boulardii may reduce the incidence of antibiotic-associated diarrhea therefore improving the symptom of diarrhea in older inpatients.
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Objective To discuss the clinical observation of Montmorillonite combined with Compound Eosinophil-Lactobacillus Tablet in the treatment of pneumonia infants of antibiotic associated diarrhea (AAD).Methods Eighty pneumonia infants with antibiotic associated diarrhea were selected,they were divided into two groups according to the random number table method.The observation group (41 cases) was given Montmorillonite.The control group (39 cases) was given Montmorillonite and Compound Eosinophil-Lactobacillus.The efficacy of Montmorillonite combined with compound Eosinophil-Lactobacillus Tablet in the treatment of pneumonia infants of antibiotic associated diarrhea was evaluated by efficacy,clinical symptom,immune function changes and adverse reactions during the treatment period.Results After treatment,the effective rate of observation group was higher than that of the control group (P ＜ 0.05).After treatment,the fever time,correcting dehydration time,and antidiarrheal time of observation group was shorter than that of the control group (P ＜ 0.05).After treatment,the serum IgG,IgA,and T lymphocyte subsets of CD3+,CD4+ levels were significantly increased in the observation group (P ＜ 0.05).There was no statistical significance on CD8+ before and after treatment.In contrast,there were no statistical significance on the serum immunoglobulin and T lymphocyte subsets before and after treatment in the control group.During the treatment period,no adverse reaction occurred in two groups.Conclusion In summary,Montmorillonite combined with Compound Eosinophil-Lactobacillus Tablet had a good effect on AAD.They could quickly improve the symptoms of diarrhea and immunoglobulin levels in children.It was worthy of clinical use.
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Objective To observe clinical efficacy of probiotics agents in the prevention and treatment of severe pulmonary infection in elderly patients with antibiotic-associated diarrhea (AAD).Methods 60 cases of elderly patients with severe pulmonary infection (more than or equal to 60 years old) were randomly divided into the treatment group ( 31 cases ) and control group ( 29 cases ) , the control group received broad-spectrum antibiotics or using two linked above anti-infection treatment, the treatment group were added with probiotic agent ( lactobacillus complex capsules).The diarrhea, the use of antibiotics and the stool routine, bacteria before and after 5, 10, 15 days of group were observed.Results After 15 days treatment, the number of Escherichia coli in treatment group was lower than that in control group (P<0.05), the number of Bacterium lacticum and Bifidobacterium bifidum in treatment group were higher than those in control group ( P<0.05 ) .The AAD rate in treatment goup was 12.90%, which was lower than 41.38% in control group (P<0.05).There were significant differences in beginning time and duration of diarrhea between two groups (P<0.05). Conclusion The intestinal probiotics reduced induced by antibiotics in elderly patients with severe pulmonary infection , the probiotics agents could redress intestinal flora imbalance, keep the steady state of intestinal flora, and prevent and cure the antibiotic-associated diarrhea.
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Objective To explore the clinical manifestations ,risk factors and treatment of antibiotic asso-ciated diarrhea(AAD)in senile patients with severe bacterial pneumonia. Methods Retrospective analysis was made on senile patients of bacterial pneumonia combined with antibiotic associated diarrhea. Results There were 114 patients out of 572 cases had AAD. The incidence of AAD in these senile patients was 19.93%. There were 62.28% patients more than 80 years old. The incidence AAD was 37.3% with third generation cephalosporin treat-ment,28.6% penicillin with enzyme inhibitor treatment and 19.2% with carbopenems treatment. Conclusions The high risk factors of AAD in senile patients with bacterial pneumonia include patient′s age,and time, APACHE Ⅱ,category,combination therapyof antibacterial,and invasive operations. We should pay more atten-tion to AAD and related high risk factors when using these antibiotics in clinics. Rational selection and use of anti-bacterial are important measures to stop senile patients from ADD. Pharmaceutical care could help to optimize the treatment plan and reduce its adverse reaction of antibacterial in senile patients.