Antibiotic Overuse in Children with Respiratory Syncytial Virus Lower Respiratory Tract Infection
Antibiotic Overuse in Children with Respiratory Syncytial Virus Lower Respiratory Tract Infection
复制标题
DOI：
10.1097/inf.0000000000001981
复制
发表时间：
2018-11-01
影响因子：
3.6
通讯作者：
Bont, Louis J.
中科院分区：
文献类型：
--
作者：
van Houten, Chantal B.;Naaktgeboren, Christiana;Bont, Louis J.
背景：呼吸道合胞病毒（RSV）是一岁以内下呼吸道感染（LRTI）的最常见原因。抗生素治疗被推荐用于疑似细菌合并感染的病例。这项前瞻性研究的目的是估计细菌合并感染的发病率和抗生素的滥用量在儿童感染RSV使用专家小组diagnosis.Methods：儿童1个月及以上的LRTI或发热无源前瞻性招募在荷兰和以色列的医院。经鼻拭子聚合酶链反应（PCR）确诊为RSV感染的儿童由专家小组评估，作为诊断的参考标准。三位经验丰富的儿科医生区分细菌合并感染从简单的病毒感染，使用所有可用的临床信息，包括所有的微生物学评价和28天的随访evaluation.Results：共有188名儿童（24%的所有784招募患者）RSV阳性。其中92例（49%）接受了抗生素治疗。所有27例合并细菌感染的儿童（29%）均接受了抗生素治疗。57例患者（62%）接受抗生素治疗，未诊断出细菌合并感染。在8的92（9%），专家小组不能区分简单的病毒感染从细菌coinfection.Conclusion：这是第一个前瞻性的国际多中心RSV研究使用专家小组作为参考标准，以确定儿童与无细菌合并感染。所有细菌合并感染的病例都得到了治疗，而多达三分之一的RSV LRTI儿童不必要地接受抗生素治疗。
Background: Respiratory syncytial virus (RSV) is the most common cause of lower respiratory tract infections (LRTI) during the first year of life. Antibiotic treatment is recommended in cases suspected of bacterial coinfection. The aim of this prospective study was to estimate the incidence of bacterial coinfections and the amount of antibiotic overuse in children infected with RSV using expert panel diagnosis.Methods: Children 1 month of age and over with LRTI or fever without source were prospectively recruited in hospitals in the Netherlands and Israel. Children with confirmed RSV infection by Polymerase Chain Reaction (PCR) on nasal swabs were evaluated by an expert panel as reference standard diagnosis. Three experienced pediatricians distinguished bacterial coinfection from simple viral infection using all available clinical information, including all microbiologic evaluations and a 28-day follow-up evaluation.Results: A total of 188 children (24% of all 784 recruited patients) were positive for RSV. From these, 92 (49%) were treated with antibiotics. All 27 children (29%) with bacterial coinfection were treated with antibiotics. Fifty-seven patients (62%) were treated with antibiotics without a diagnosis of bacterial coinfection. In 8 of the 92 (9%), the expert panel could not distinguish simple viral infection from bacterial coinfection.Conclusion: This is the first prospective international multicenter RSV study using an expert panel as reference standard to identify children with and without bacterial coinfection. All cases of bacterial coinfections are treated, whereas as many as one-third of all children with RSV LRTI are treated unnecessarily with antibiotics.