Derya GÜMÜŞ, Ergin ÇİFTÇİ, Erdal İNCE, Ülker DOĞRU

Çocuklarda Clostridium difficile'ye bağlı kolit

Amaç: Clostridium difficile'ye bağlı kolit gelişen çocuk-ların değerlendirilmesi. Yöntem: Ankara Üniversitesi Tıp Fakültesi Çocuk İnfeksi-yon Hastalıkları Servisi'nde Ocak 2001 ve Haziran 2002 tarihleri arasındaki dönemde Clostridium difficile koliti tanısı alan 10 hasta retrospektif olarak değerlendirilmiştir. Bulgular: Hastaların yaş ortalaması 10.1$pm$4.6yıldı. Hastaların 5'i kız ve 5'i erkekti. En sık başvuru yakınması karın ağrısı ve diyareydi. Hastaların tümünde antibiyotik kullanma öyküsü bulunuyordu. Hastaların 9 tanesi ampisilin-sulbaktam, l tanesi klaritromisin kullanmaktaydı. Hastaların yakınmaları antibiyotik tedavisinin ortalama 4.1 ±1.3 (3-6 gün) gününde ortaya çıkmıştı. Fizik incelemede saptanan en sık bulgular hafif derecede dehidratasyon ve bağırsak seslerinin hiperaktifleşmesiydi. Bütün hastalarda makroskopik olarak kanlı ve mukuslu dışkılama ve dışkı mikroskopisinde bol lökositve eritrosit görüldü. C. difficile enterokoliti tanısı dışkı örneklerinde C. difficile toksin A pozitifliğine dayanarak konuldu. Hastalardan dokuzu has-taneye yatırılarak izlenirken bir hasta da ayaktan izlendi. Hastaların hepsine 10 gün süreyle metronidazol ve 6 hastaya S. boulardii içeren preparat verildi. Bu tedaviyle hastaların yakınmalarından kanlı dışkılama ortalama 2.4$pm$0.6 (2-4 gün) günde ve karın ağrısı 3.6$pm$1.0 (2-5 gün) günde düzeldi. Hastaneye yatırılan hastaların hastanede kalış süresi ortalama 4.l ±1.7 gün (2-8 gün) olarak gerçekleşti. Hiçbir hastada toksik megakolon ve fulminan kolit gelişmedi. Tedavi sonrası relaps gelişen hasta olmadı. Sonuç: Geniş spektrumlu antibiyotiklerin gereksiz yere kullanılması çocuklarda C. difficile'ye bağlı kolit gelişimine neden olabilir. Hastanın aldığı antibiyotiğin kesilmesi, sıvı ve elektrolit dengesinin sağlanması, metronidazol ve seçilmiş olgularda S. boulardii preparatıyla hastalar başarıyla tedavi edilebilmektedir.

Anahtar Kelimeler:

Kolit, Çocuk, Geriyedönük çalışma, Anti-bakteriyel ajanlar, Clostridium difficile

Clostridium difficile associated colitis in children

Objective: To evaluate the clinical features of patients diagnosed as Clostridium difficile colitis. Methods: Ten patients with C. difficile associated colitis at Ankara University Medical School Department of Pediatric Infectious Diseases between January 2001 and June 2002 were evaluated retrospectively. Results: The mean age of the patients was 10.1$pm$4.6 years. Five of them were females and 5 were males. The most common complaints on admission were abdominal pain and diarrhea. All patients had a history of antibiotic use. Nine of the patients were taking ampicillin-sulbactam, and one patient was taking clarithromycin. The complaints of patients had appeared on mean 4.1 ±1.3 days (3 to 6 days) of the therapy. The most common physical examination findings were mild dehydration and bowel hyperactivity. All patients had macroscopically bloody and mucoid stool and abundant leukocyte and erythrocyte on microscopic examination of stool. The diagnosis of C. difficile associated colitis was established based on positive C. difficile toxin A test of the stool specimens. Nine of the patients were hospitalized while one patient was followed as out-patient. All patients were treated with metronidazolefor 10 days and 6patients were also treated by S. boulardii containing preparetes. Of the complaints of the patients, bloody defecation and abdominal pain resolved on the mean of 2.4$pm$0.6 days (2 to 8 days). None of the patients developed toxic megacolon and fulminan colitis. Conclusion: Inappropriate use of broad-spectrum antibiotics may result in C. difficile colitis in children. The patients can be sucesfully managed with discontinuation of antibiotics, fluid and electrolyte therapy, metronidazole, and S. boulardii in selected patients.

Keywords:

Colitis, Child, Retrospective Studies, Anti-Bacterial Agents, Clostridium difficile,

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