Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Stampfer, L.
Systematische Erhebung von Hämatochezie im Kindes- und Jugendalter mit besonderem Augenmerk auf Antibiotika-assoziierte hämorrhagische Kolitis und den enteralen Pathobionten Klebsiella oxytoca
Humanmedizin; [ Diplomarbeit ] Medical University of Graz; 2014. pp.
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- Autor*innen der Med Uni Graz:
- Stampfer Laura
- Betreuer*innen:
- Hoegenauer Christoph
- Hoffmann Karl Martin
- Altmetrics:
- Abstract:
- Objectives and Study: Hematochezia in children and adolescents is a troubling sign for parents as well as for physicians. The spectrum of underlying diseases is diverse and ranges from benign to potentially life-threatening. Systematic pediatric data on the causes of hematochezia are scarce. This prospective study aimed at elucidating the range of disorders causing hematochezia in children. A second aim of this study was to investigate antibiotic-associated colitis (AAC) presenting with hematochezia, focusing on antibiotic-associated hemorrhagic colitis (AAHC), a recently described entity caused by Klebsiella (K.) oxytoca. Currently the preconditions, incidence and age pattern of AAHC in children and adolescents are unclear. Methods: Infants, children and adolescents with visible bloody stool were prospectively recruited at 5 different Austrian pediatric hospitals between May 2011 and December 2012. Patients were grouped in infants (<1 year), young children (1-5 years), children (6-13 years) and adolescents (≥14 years). We included patients with confirmed hematochezia and, as an addition to routine diagnostics, a stool culture for K. oxytoca. Further clinical investigations or therapy were not influenced by the study. We collected data of patients’ history, laboratory findings, infectiological investigations, imaging, final diagnosis and clinical course. K.oxytoca species were identified by the API 20E test. Results: We included 221 patients (female n=102, 46%): 57 infants, 64 young children, 46 children and 54 adolescents. 17 (7.7%) of all patients had a positive stool culture for K. oxytoca. In 129 (58%) of patients hematochezia was caused by infectious diseases. In 51 (23%) of all patients no final diagnosis could be made and hematochezia resolved spontaneously. Thirty (14%) patients underwent endoscopy, which led to a definite diagnosis in 17/30 (57%). 21 (9.5%) patients were diagnosed with diseases that occurred only once or twice within this study. The most common diagnoses in regard to age groups were: Food protein-induced proctocolitis in infants (n=19, 33%), bacterial enterocolitis (Campylobacter/Salmonella; n=34, 53%) in young children and inflammatory bowel disease in children (n=10, 22%) and adolescents (n=11, 20%). AAC was diagnosed in 12 (5%) patients: 2 young children with C. difficile, 2 infants with AAHC; in the remaining 8/12 (67%) with the clinical diagnosis of AAC no known pathogen was identified. Conclusion: Hematochezia was caused by infections in the majority of patients. In most patients invasive diagnostic procedures were not necessary. Thus, in children with hematochezia indication for endoscopy should be restrictive, especially in infants and young children. AAC presenting with hematochezia might be caused by pathogens other than C. difficile and K. oxytoca. AAHC, caused by K. oxytoca, was a rare diagnosis.