Antibiotic use for respiratory syncytial virus in the Middle East: A surveillance study in hospitalized Jordanian children.
Antibiotic use for respiratory syncytial virus in the Middle East: A surveillance study in hospitalized Jordanian children.
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DOI：
10.1371/journal.pone.0260473
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Halasa NB
中科院分区：
文献类型：
--
作者：
Rankin DA;Khankari NK;Haddadin Z;Hamdan O;Yanis A;Faouri S;Shehabi A;Williams JV;Khuri-Bulos N;Halasa NB
在发展中国家，即时检测有限，提供者依靠临床判断来区分病毒和细菌呼吸道感染。我们对住院的约旦儿童进行了一项横断面队列研究，以评估抗生素用于呼吸道合胞病毒（RSV）感染的情况。从先前的病毒监测队列住院的约旦儿童入院诊断分为疑似病毒样，非肺部细菌样和肺部细菌样感染。按性别分层，我们进行了多分类logistic回归分析，调整了年龄、基础医疗状况、母亲教育程度和居住地区，以估计住院期间抗生素使用的患病率比值比（POR）。入院诊断和研究实验室结果的敏感性和特异性进行了比较。与疑似非肺部细菌样感染的儿童相比，疑似病毒样感染的儿童使用经验性/一线抗生素的可能性分别为88%和86%（男性，aPOR：0.12;女性，aPOR：0.14; p值= <0.001）。在使用扩大覆盖范围抗生素方面，男性的患病率低于女性，但在非肺部细菌样感染方面，男性的大环内酯类用药患病率高于男性。总的来说，RSV患儿有34%的概率（敏感性）被分配到疑似病毒样诊断;而RSV阴性儿童有76%的概率（特异性）被分配到疑似肺部细菌样诊断。与疑似非肺部感染和肺部感染相比，疑似病毒样入院诊断的住院儿童接受经验性/一线和扩大覆盖范围抗生素的可能性较小;然而，当评估入院诊断与RSV实验室结果的准确性时，存在相当大的错误分类。这些结果强调了为约旦和中东其他地区开发抗生素干预措施的必要性。
In developing countries where point-of-care testing is limited, providers rely on clinical judgement to discriminate between viral and bacterial respiratory infections. We performed a cross-sectional cohort study of hospitalized Jordanian children to evaluate antibiotic use for respiratory syncytial virus (RSV) infections. Admitting diagnoses from a prior viral surveillance cohort of hospitalized Jordanian children were dichotomized into suspected viral-like, non-pulmonary bacterial-like, and pulmonary bacterial-like infection. Stratifying by sex, we performed a polytomous logistic regression adjusting for age, underlying medical condition, maternal education, and region of residence to estimate prevalence odds ratios (PORs) for antibiotic use during hospitalization. Sensitivity and specificity of admission diagnoses and research laboratory results were compared. Children with a suspected viral-like admission diagnosis, compared to those with suspected non-pulmonary bacterial-like, were 88% and 86% less likely to be administered an empiric/first-line antibiotic (male, aPOR: 0.12; female, aPOR: 0.14; p-value = <0.001). There were slight differences by sex with males having a lower prevalence than females in being administered an expanded coverage antibiotic; but they had a higher prevalence of macrolide administration than males with non-pulmonary bacterial-like infection. Overall, children with RSV had a 34% probability (sensitivity) of being assigned to a suspected viral-like diagnosis; whereas RSV-negative children had a 76% probability (specificity) of being assigned to a suspected pulmonary bacterial-like diagnosis. Hospitalized children with a suspected viral-like admission diagnosis were less likely to receive an empiric/first-line and expanded coverage antibiotic compared to suspected non-pulmonary and pulmonary infections; however, when evaluating the accuracy of admission diagnosis to RSV-laboratory results there were considerable misclassifications. These results highlight the need for developing antibiotic interventions for Jordan and the rest of the Middle East.
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