A Cross-Sectional Survey of Pediatric Infectious Disease Physicians' Approach to Congenital Cytomegalovirus Infection.
A Cross-Sectional Survey of Pediatric Infectious Disease Physicians' Approach to Congenital Cytomegalovirus Infection.
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DOI：
10.3390/ijns9020017
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发表时间：
2023-03-24
影响因子：
3.5
通讯作者：
中科院分区：
文献类型：
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作者：
先天性巨细胞病毒（cCMV）仍然是一个主要的公共卫生保健问题，由于其在世界各地的高患病率。然而，缺乏评估提供者如何管理这种感染的研究。本研究调查了北美儿科传染病（PID）的医生，以引出他们对这种疾病的评估和治疗方法。32名PID医生回应了这项调查。机构检测和筛查cCMV的报道很少。除了神经成像之外，受访者普遍同意大多数实验室和诊断测试。对于这些测试，头部超声和脑部MRI成像的适应症存在差异。大多数（68.8%）的人同意临床实践中对有疾病体征或症状的小于1个月的婴儿开始使用缬更昔洛韦，62.5%的人同意对孤立性感音神经性听力损失的婴儿开始使用缬更昔洛韦。然而，只有28.1%的人会治疗1个月以上感染ccmv的婴儿。总之，在这个队列中，以PID医生为代表的医疗机构很少有cCMV筛查或检测的主动性，但大多数受访者会根据他们的临床实践进行更高水平的检测。虽然在这些儿童的评估和治疗方面存在普遍共识，但在神经影像学和抗病毒治疗指征方面的实践与年龄和疾病严重程度有关。迫切需要一个基于证据的政策声明来规范cCMV的检查和治疗。
Congenital cytomegalovirus (cCMV) continues to be a major public health care issue due to its high prevalence throughout the world. However, there is a paucity of studies evaluating how providers manage this infection. This study surveyed North American Pediatric Infectious Disease (PID) physicians to elicit their approach towards the evaluation and treatment of this condition. Thirty-two PID physicians responded to this survey. Institutional testing and screening for cCMV were infrequently reported. The respondents in general agreed upon most laboratory and diagnostic testing except for neuroimaging. For those tests, there was a disparity in indications for head ultrasound versus brain MRI imaging. Most (68.8%) agreed with the clinical practice of starting valganciclovir in an infant less than 1 month of age with one sign or symptom of disease, and 62.5% would do so for an infant with isolated sensorineural hearing loss. However, only 28.1% would treat cCMV-infected infants older than 1 month of age. In conclusion, few healthcare institutions represented by PID physicians in this cohort had a cCMV screening or testing initiative, yet most respondents would test at a much higher level based on their clinical practice. While there is general consensus in evaluation and treatment of these children, there are disparities in practices regarding neuroimaging and indications for antiviral treatment with respect to age and severity of disease. There is a great need for an evidence based policy statement to standardize cCMV workup and treatment.