Reference Value Of Fecal Bacterial Smears For Antibiotic Treatment Of Diarrhea Irritable Bowel Syndrome

Objective:To compare the changes and improvement of symptoms of stool smear flora in patients with diarrhea irritable bowel syndrome(IBS-D)before and after treatment with rifaximin,to explore the reference value of fecal bacterial smears for antibiotic treatment of diarrhea-type irritable bowel syndrome.Methods:A total of 130 IBS-D patients who were treated in the Department of Gastroenterology of Cangzhou People’s Hospital from January 2018 to January 2019 were selected,and fecal bacterial smear tests were performed before treatment.According to the test results,it is divided into the normal group of bacteria(group A)and the group of abnormal flora.The abnormal flora group included the I degree flora imbalance group(group B),the second degree flora group(group C),and the third degree group imbalance group(group D).Groups A、Band C were treated with rifaximin 200mg/Tid for 7 days.Group D for bacterial culture or other pathogenic examinations,and sensitive antibiotics were selected according to the results of culture and drug susceptibility.On the second day after the end of treatment and 4 weeks after drug withdrawal,all patients reviewed the bacterial smears of the feces,and recorded the improvement of symptoms such as the degree of abdominal pain,frequency of diarrhea,defecation traits,and the changes of bacterial smears of the feces.Calculate the proportion of patients in each group;compare the treatment effect of rifaximin in normal flora and abnormal flora(group B + group C);The treatment effect and fecal bacteria improvement of each subgroup in the abnormal bacteria group were compared,and the consistency of the treatment effect and fecal bacteria improvement was tested.Results:1.82.31% of the patients with IBS-D have intestinal microflora disorders,among which 48.46%,25.38% and 8.46% of patients have degree I,II,and III degree microflora disorders,respectively.2.The effective rates at the end of treatment were 30.43% and 57.29% in group A and abnormal bacteria group(group B and group C),respectively,the difference was statistically significant(χ~2 = 5.363,P <0.05);The effective rates were 21.74% and 45.83%,respectively,and the difference was statistically significant(χ~2 = 4.447,P <0.05);3.After rifaximin treatment was completed,the effective rates of t he abnormal flora group B and group C were 52.38% and 66.67%,re spectively,the difference was not statistically significant(χ~2=1.806,P>0.05);effective after 4 weeks of withdrawal They were 42.86% and 51.52%,respectively,and the difference was not statistically significant(χ~2=0.550,P>0.05).4.In the abnormal flora group,7 cases in group D were G+cocci infections,3 cases were yeast-like infections,and 1 case was C.diffici le infection.Six of these patients reviewed the colonoscopy and found obvious mucosal inflammatory changes.The effective rate was 72.73% after selecting the corresponding antibacterial drugs,and the effectiv e rate was 63.64% after 4 weeks of drug withdrawal.5.The rate of improvement in the bacterial smear flora imbalance in groups B,C,and D at the end of treatment was 60.32%,78.79%,and 72.73%,respectively;the improvement rate in the bacterial smear flora imbalance in the three groups after 4 weeks They were 39.68%,57.57%,and 45.45%.6.Consistency evaluation: At the end of treatment,groups B,C,a nd D had better consistency with the improvement of fecal bacterial s mear,and group D had better consistency(group B Kappa=0.653,P<0.05;Group C Kappa=0.727,P<0.05;Group D Kappa=1.000,P<0.05);after 4weeks of withdrawal,groups B、Cand D had good consistency with the improvement of fecal bacterial smear(group B Kappa=0.607,P<0.05;Group C Kappa=0.513,P<0.05;Group D Kappa=0.645,P<0.05)Conclusion:1.IBS-D patients have a higher proportion of patients with intestinal flora imbalance,the highest proportion of patients with first degree flora imbalance.2.Rifaximin is more effective for IBS-D patients with mild to moderate intestinal microflora disorders,and patients with severe microflora disorders also have a good effect after treatment with antibacterial drugs.3.The fecal bacterial smear has a certain reference value for the clinical application of antibiotics in IBS-D patients.