Association between early antibiotic treatment and clinical outcomes in children hospitalized for asthma exacerbation
Association between early antibiotic treatment and clinical outcomes in children hospitalized for asthma exacerbation
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DOI：
10.1016/j.jaci.2020.05.030
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发表时间：
2021-01-05
影响因子：
14.2
通讯作者：
Yasunaga, Hideo
中科院分区：
文献类型：
--
作者：
Okubo, Yusuke;Horimukai, Kenta;Yasunaga, Hideo
背景：专业协会指南建议不要在没有合并细菌感染的情况下常规早期使用抗生素来治疗哮喘发作。然而，发达国家报告了较高的抗生素处方率。目的：我们试图评估这一策略在儿童常规护理中的有效性。方法：利用 2010 年至 2018 年期间 48,743 名因哮喘发作而住院且无细菌感染迹象的儿童的数据，我们进行了一项回顾性队列研究，以比较接受早期抗生素治疗和未接受抗生素治疗的儿童的临床结果和资源利用率。结果：总体而言， 19,866 名儿童（41%）接受了早期抗生素治疗。根据倾向评分匹配分析，与早期接受抗生素治疗的儿童相比，早期接受抗生素治疗的儿童住院时间更长（平均差为 0.21 天；95% CI，0.18-0.28），住院费用更高（平均差为 83.5 美元；95% CI，62.9104.0），益生菌使用风险也更高（风险比，2.01；95% CI，1.81-2.23）。没有接受早期抗生素治疗。从处理权重的逆概率、g 计算、工具变量方法和敏感性分析中也发现了类似的结果。机械通气和 30 天再入院的风险在各组之间相似或在治疗组中略高，具体取决于统计模型。结论：抗生素治疗可能与住院时间延长、住院费用增加以及益生菌使用的高风险有关，而无法改善治疗失败和再入院。我们的研究结果强调需要减少因哮喘住院的儿童的不当抗生素使用。
Background: Professional society guidelines recommend against routine early antibiotic use in the treatment of asthma exacerbation without comorbid bacterial infection. However, high antibiotic prescribing rates have been reported in developed countries.Objective: We sought to assess the effectiveness of this strategy in the routine care of children.Methods: Using data on 48,743 children hospitalized for asthma exacerbation with no indication of bacterial infection during the period 2010 to 2018, we conducted a retrospective cohort study to compare clinical outcomes and resource utilization between children who received early antibiotic treatment and those who did not.Results: Overall, 19,866 children (41%) received early antibiotic treatment. According to the propensity score matching analysis, children with early antibiotic treatment had longer hospital stay (mean difference, 0.21 days; 95% CI, 0.18-0.28), higher hospitalization costs (mean difference, $83.5; 95% CI, 62.9104.0), and higher risk of probiotic use (risk ratio, 2.01; 95% CI, 1.81-2.23) than children who did not receive early antibiotic therapy. Similar results were found from inverse probability of treatment weighting, g-computation, and instrumental variable methods and sensitivity analyses. The risks of mechanical ventilation and 30-day readmission were similar between the groups or slightly higher in the treated group, depending on the statistical models.Conclusions: Antibiotic therapy may be associated with prolonged hospital stay, elevated hospitalization costs, and high risk of probiotic use without improving treatment failure and readmission. Our findings highlight the need for reducing inappropriate antibiotic use among children hospitalized for asthma.