Epidemiology and Impact of Campylobacter Infection in Children in 8 Low-Resource Settings: Results From the MAL-ED Study.
Epidemiology and Impact of Campylobacter Infection in Children in 8 Low-Resource Settings: Results From the MAL-ED Study.
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DOI：
10.1093/cid/ciw542
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发表时间：
2016-11-01
期刊：
影响因子：
--
通讯作者：
Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project (MAL-ED) Network Investigators
中科院分区：
文献类型：
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作者：
Amour C;Gratz J;Mduma E;Svensen E;Rogawski ET;McGrath M;Seidman JC;McCormick BJ;Shrestha S;Samie A;Mahfuz M;Qureshi S;Hotwani A;Babji S;Trigoso DR;Lima AA;Bodhidatta L;Bessong P;Ahmed T;Shakoor S;Kang G;Kosek M;Guerrant RL;Lang D;Gottlieb M;Houpt ER;Platts-Mills JA;Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project (MAL-ED) Network Investigators
在一项多地点出生队列研究中，我们使用酶免疫分析法记录了弯曲杆菌感染的高负担，证明弯曲杆菌与线性生长不足、肠道通透性增加和肠道和全身炎症之间存在关联，并确定了潜在的干预措施。背景。在低资源环境中，肠道病原体感染与肠道功能障碍和生长受损有关。在一项多地点出生队列研究（MAL-ED）中，我们描述了弯曲杆菌感染在生命最初2年的流行病学和影响。方法。孩子们被积极地随访到24个月大。收集腹泻和非腹泻粪便标本，采用酶免疫法检测弯曲杆菌。粪便和血液样本检测肠通透性和炎症标志物。结果。1892名儿童中，有7601例腹泻和26267例非腹泻粪便样本检测弯曲杆菌。我们描述了感染的高患病率，大多数儿童（n = 1606; 84.9%）在1岁时粪便样本呈弯曲杆菌阳性。与弯曲杆菌检测风险降低相关的因素包括纯母乳喂养（风险比，0.57；95%可信区间，0.47 -）。67)，饮用水处理（0.76;0.70-0.83），获得改善的厕所（0.89;0.82-0.97），以及最近使用大环内酯类抗生素（0.68;0.63-0.74）。与低负荷（- 1.49;- 1.60至- 1.38）相比，高弯曲杆菌负荷与24个月时较低的年龄长度Z评分相关（- 1.82；95%置信区间，- 1.94至- 1.70）。这种关联对于混杂因素是强有力的，并且跨站点是一致的。弯曲杆菌感染还与肠通透性增加以及肠道和全身炎症有关。结论。弯曲杆菌在不同环境中普遍存在，并与生长不足有关。促进纯母乳喂养、饮用水处理、改善厕所和有针对性的抗生素治疗可以减轻弯曲杆菌感染的负担，并改善这些环境中儿童的生长。
In a multisite birth cohort study, we document a high burden of Campylobacter infection using enzyme immunoassay, demonstrate an association between Campylobacter and linear growth shortfalls and both increased intestinal permeability and intestinal and systemic inflammation, and identify potential interventions. Background. Enteropathogen infections have been associated with enteric dysfunction and impaired growth in children in low-resource settings. In a multisite birth cohort study (MAL-ED), we describe the epidemiology and impact of Campylobacter infection in the first 2 years of life. Methods. Children were actively followed up until 24 months of age. Diarrheal and nondiarrheal stool samples were collected and tested by enzyme immunoassay for Campylobacter. Stool and blood samples were assayed for markers of intestinal permeability and inflammation. Results. A total of 1892 children had 7601 diarrheal and 26 267 nondiarrheal stool samples tested for Campylobacter. We describe a high prevalence of infection, with most children (n = 1606; 84.9%) having a Campylobacter-positive stool sample by 1 year of age. Factors associated with a reduced risk of Campylobacter detection included exclusive breastfeeding (risk ratio, 0.57; 95% confidence interval, .47–.67), treatment of drinking water (0.76; 0.70–0.83), access to an improved latrine (0.89; 0.82–0.97), and recent macrolide antibiotic use (0.68; 0.63–0.74). A high Campylobacter burden was associated with a lower length-for-age Z score at 24 months (−1.82; 95% confidence interval, −1.94 to −1.70) compared with a low burden (−1.49; −1.60 to −1.38). This association was robust to confounders and consistent across sites. Campylobacter infection was also associated with increased intestinal permeability and intestinal and systemic inflammation. Conclusions. Campylobacter was prevalent across diverse settings and associated with growth shortfalls. Promotion of exclusive breastfeeding, drinking water treatment, improved latrines, and targeted antibiotic treatment may reduce the burden of Campylobacter infection and improve growth in children in these settings.
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