成人粪白细胞1-14/HPF的非血便急性感染性腹泻患者病原及抗生素应用的探讨

doi:10.5246/jcps.2015.02.014

中国药学(英文版) ›› 2015, Vol. 24 ›› Issue (2): 121-127.DOI: 10.5246/jcps.2015.02.014

成人粪白细胞1-14/HPF的非血便急性感染性腹泻患者病原及抗生素应用的探讨

侯凤琴, 孙新婷, 王贵强^*

北京大学第一医院感染疾病科, 北京 100034

收稿日期:2014-09-09 修回日期:2014-11-25 出版日期:2015-02-01 发布日期:2014-12-18
通讯作者: Tel.: 86-10-83572362, Fax: 86-10-66551680
基金资助:
Major National Science and Technology Projects (Grant No. 2013ZX10004605, 2013ZX10004605001004).

Pathogens and possible opinion for antibiotic treatment in adult patients with 1-14 fecal WBC/HPF of acute non-bloody diarrhea

Fengqin Hou, Xinting Sun, Guiqiang Wang^*

Department of Infectious Diseases, Peking University First Hospital, Beijing 100034, China

Received:2014-09-09 Revised:2014-11-25 Online:2015-02-01 Published:2014-12-18
Contact: Tel.: 86-10-83572362, Fax: 86-10-66551680
Supported by:
Major National Science and Technology Projects (Grant No. 2013ZX10004605, 2013ZX10004605001004).

摘要/Abstract

摘要：

本研究目的探讨成人粪白细胞1–14个/HPF的非血便急性感染性腹泻患者病因学及抗生素应用的参考条件。在成人肠道门诊筛选粪检白细胞1–14个/HPF的非血性急性感染性腹泻患者, 留取粪便标本进行细菌培养和病毒检测。196例患者参加了研究, 平均年龄(37.9±17.4)岁, 女性42.3%。细菌的检出率为63 (32.1%), 病毒的检出率为21 (10.7%)。分离的细菌中, 弯曲菌14 (22.0%)为最常见菌。病毒分离中, 杯状病毒10 (47.6%)占第一位。实验室诊断的单一病原感染的侵袭腹泻46例, 非侵袭腹泻26例, 侵袭腹泻的发热患者体温显著高于非侵袭腹泻的发热患者((38.4±0.7) ºC vs (37.7±0.4) ºC, P = 0.002)。T>38.4 ºC的患者为侵袭性腹泻的几率高于T≤38.4 ºC的患者(RR = 1.5)。成人粪白细胞1–14/HPF的非血性腹泻人群如采用T>38.4 ºC作为抗生素应用的界限值, 抗生素的过度使用将由26.9% 下降至3.8% (P = 0.021)。成人粪白细胞1–14/HPF的急性非血性腹泻患者, T>38.4 ºC可一定程度上作为应用抗生素的参考。

关键词: 急性感染性腹泻, 粪白细胞, 病原, 抗生素

Abstract:

The pathogens and opinion for antibiotic treatment in adult patients with 1–14 fecal white blood cells per high power field (WBC/HPF) of acute non-bloody diarrhea remain obscure. The study attempts to clarify it. Stool specimens of adult patients with acute non-bloody diarrhea and stool examination showing 1–14 fecal WBC/HPF were collected for bacterial culture and viral detection. Patients included in this study were 196 cases with mean age of (37.9±17.4) years and 42.3% was women. The bacterial and viral detection rates were 63 (32.1%) and 21 (10.7%), respectively. Of the isolated pathogens, campylobacteria was present in 14 (22.0%) samples and was the most common bacteria and calicivirus was found in 10 (47.6%) samples and was the most common virus. Based on single pathogens, 46 cases were caused by invasive pathogens, 26 cases were caused by non-invasive pathogens. The body temperature was significantly higher in feverish patients caused by invasive pathogens than those caused by non-invasive pathogens ((38.4±0.7) ºC vs (37.7±0.4) ºC, P = 0.002). The probability of diarrhea caused by invasive pathogens was higher in patients with T>38.4 ºC than those with T≤38.4 ºC (RR = 1.5). When T>38.4 ºC is used as the threshold for antibiotic treatment, the misuse rate of antibiotics would decrease from 26.9% to 3.8% (P = 0.021). So T>38.4 ºC may be used as a possible reference value for antibiotic treatment in adult patients with 1–14 fecal WBC/HPF of acute non-bloody diarrhea.

Key words: Acute infectious diarrhea, Fecal white blood cells, Pathogens, Antibiotics

中图分类号:

R915

Supporting:

侯凤琴, 孙新婷, 王贵强. 成人粪白细胞1-14/HPF的非血便急性感染性腹泻患者病原及抗生素应用的探讨[J]. 中国药学(英文版), 2015, 24(2): 121-127.

Fengqin Hou, Xinting Sun, Guiqiang Wang. Pathogens and possible opinion for antibiotic treatment in adult patients with 1-14 fecal WBC/HPF of acute non-bloody diarrhea[J]. Journal of Chinese Pharmaceutical Sciences, 2015, 24(2): 121-127.

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成人粪白细胞1-14/HPF的非血便急性感染性腹泻患者病原及抗生素应用的探讨

Pathogens and possible opinion for antibiotic treatment in adult patients with 1-14 fecal WBC/HPF of acute non-bloody diarrhea

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