Rurality of Residence and Inappropriate Antibiotic Use for Acute Respiratory Infections Among Young Tennessee Children.
Rurality of Residence and Inappropriate Antibiotic Use for Acute Respiratory Infections Among Young Tennessee Children.
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DOI：
10.1093/ofid/ofaa587
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发表时间：
2021-01
影响因子：
4.2
通讯作者：
Grijalva CG
中科院分区：
文献类型：
--
作者：
Dantuluri KL;Bruce J;Edwards KM;Banerjee R;Griffith H;Howard LM;Grijalva CG
抗生素的使用在儿童急性呼吸道感染(ARI)中很常见，但这种使用在很大程度上是不合适的。很少有研究检查居住的乡村是否与不适当的抗生素使用有关。我们检查了儿童中与ARI相关的不适当使用抗生素的比率是否因居住的乡村而不同。我们对2007至2017年间参加田纳西州医疗补助计划的2个月至5岁的儿童进行了一项回顾性队列研究，这些儿童在门诊环境中被诊断为ARI。研究结果包括ARI、ARI相关的抗生素使用和ARI相关的不当抗生素使用。多变量泊松回归被用来衡量美国人口普查局定义的居住乡村与研究结果比率之间的关联，同时考虑了其他因素，包括人口统计数据和潜在的合并症。共有805332名儿童符合选择标准，贡献了1840048人年(p-y)的观察。居住在完全农村、主要是农村和大部分城市县的儿童分别贡献了70369(4%)p-y、479121(26%)p-y和1290558(70%)p-y。与城市儿童(238/1000)相比，农村儿童(450/1000)和全农村儿童(468/1000)使用抗生素的不合格率较高(校正发病率比[aIRR]=1.34，95%可信区间[CI]=1.33~1.35；aIRR=1.33，95%CI=1.32~1.35)。不适当的抗生素使用在患有ARI的幼儿中很常见，农村的发病率高于城市县。这些差异应该为有针对性的门诊抗生素管理工作提供信息。与居住在城市县的儿童相比，居住在农村县的儿童不适当使用抗生素的比率高出30%以上。与农村居住地相关的因素可以纳入有针对性的门诊抗生素管理计划。
Antibiotic use is common for acute respiratory infections (ARIs) in children, but much of this use is inappropriate. Few studies have examined whether rurality of residence is associated with inappropriate antibiotic use. We examined whether rates of ARI-related inappropriate antibiotic use among children vary by rurality of residence. We conducted a retrospective cohort study of children aged 2 months–5 years enrolled in Tennessee Medicaid between 2007 and 2017 and diagnosed with ARI in the outpatient setting. Study outcomes included ARI, ARI-related antibiotic use, and ARI-related inappropriate antibiotic use. Multivariable Poisson regression was used to measure associations between rurality of residence, defined by the US Census Bureau, and the rate of study outcomes, while accounting for other factors including demographics and underling comorbidities. A total of 805 332 children met selection criteria and contributed 1 840 048 person-years (p-y) of observation. Children residing in completely rural, mostly rural, and mostly urban counties contributed 70 369 (4%) p-y, 479 121 (26%) p-y, and 1 290 558 p-y (70%), respectively. Compared with children in mostly urban counties (238 per 1000 p-y), children in mostly rural (450 per 1000 p-y) and completely rural counties (468 per 1000 p-y) had higher rates of inappropriate antibiotic use (adjusted incidence rate ratio [aIRR] = 1.34, 95% confidence interval [CI] = 1.33–1.35 and aIRR = 1.33, 95% CI = 1.32–1.35, respectively). Inappropriate antibiotic use is common among young children with ARI, with higher rates in rural compared with urban counties. These differences should inform targeted outpatient antibiotic stewardship efforts. The rate of inappropriate antibiotic use is over 30% higher among children living in rural counties compared with those living in urban counties. Factors associated with rural residence can be incorporated into targeted outpatient antibiotic stewardship programs.
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