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Comparison of pediatric and adult antibiotic-associated diarrhea and Clostridium difficile infections

World Journal of Gastroenterology 2016年第11期22卷 3078-3104页

作者： Lynne Vernice Mc Farland Metehan Ozen ener cagri dinleyici Shan Goh Department of Medicinal Chemistry School of PharmacyUniversity of Washington Faculty of Medicine Department of PediatricsDivision of Pediatric Infectious Diseaseatakent acibadem University Hospital Faculty of Medicine Department of PediatricsPediatric Intensive Care UnitEskisehir Osmangazi University Department of Pathology and Pathogen Biology Royal Veterinary College

Antibiotic-associated diarrhea(AAD) and Clostridum difficile infections(CDI) have been well studied for adult cases, but not as well in the pediatric population. Whether the disease process or response to treatments differs between pediatric and adult patients is an important clinical concern when following global guidelines based largely on adult patients. A systematic review of the literature using databases Pub Med(June 3, 1978-2015) was conducted to compare AAD and CDI in pediatric and adult populations and determine significant differences and similarities that might impact clinical decisions. In general, pediatric AAD and CDI have a more rapid onset of symptoms, a shorter duration of disease and fewer CDI complications(required surgeries and extended hospitalizations) than in adults. Children experience more community-associated CDI and are associated with smaller outbreaks than adult cases of CDI. The ribotype NAP1/027/BI is more common in adults than children. Children and adults share some similar risk factors, but adults have more complex risk factor profiles associated with more co-morbidities, types of disruptive factors and a wider range of exposures to C. difficile in the healthcare environment. The treatment of pediatric and adult AAD is similar(discontinuing or switching the inciting antibiotic), but other treatment strategies for AAD have not been established. Pediatric CDI responds better to metronidazole, while adult CDI responds better to vancomycin. Recurrent CDI is not commonly reported for children. Prevention for both pediatric and adult AAD and CDI relies upon integrated infection control programs, antibiotic stewardship and may include the use of adjunctive probiotics. Clinical presentation of pediatric AAD and CDI are different than adult AAD and CDI symptoms. These differences should be taken into account when rating severity of disease and prescribing antibiotics.

关键词： Antibiotics Antibiotic-associated diarrhea Clostridum difficile infections Adults Pediatrics Diarrhea Risk factors Treatments Prevention

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