Changes in Antibiotic Treatment for Children With Lyme Meningitis 2015-2020.
Changes in Antibiotic Treatment for Children With Lyme Meningitis 2015-2020.
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DOI：
10.1542/hpeds.2021-005909
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发表时间：
2021-10-01
影响因子：
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通讯作者：
Nigrovic, Lise E
中科院分区：
文献类型：
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作者：
Roelf, Kelly M;Garro, Aris;Nigrovic, Lise E
目的：虽然头孢曲松一直是莱姆脑膜炎的一线治疗药物，但 2020 年美国传染病学会、美国风湿病学会和美国神经病学学会指南推荐使用多西环素或头孢曲松。我们的目的是探讨莱姆脑膜炎儿童肠内抗生素治疗的最新趋势。方法：使用国际疾病分类第 10 版病例识别代码，我们对 2015 年至 2020 年在儿童健康信息系统的儿科医院就诊的 21 岁以下被诊断为莱姆脑膜炎的患者进行了一项多中心回顾性研究。我们的主要结果是肠外抗生素治疗，由程序代码定义用于留置导管或住院患者肠外莱姆病特异性治疗超过 7 天。为了检查研究期间的趋势，我们使用了广义估计方程，以肠外抗生素作为因变量，研究年份作为自变量，并根据患者年龄、性别、种族、民族和按医院聚类的保险状况进行调整。 结果：我们确定了在 24 个参与中心接受治疗的 239 名莱姆脑膜炎患者。总体而言，48 例 (20.0%) 患者接受了肠外抗生素治疗，这一比例在研究期间呈下降趋势（2015 年为 43.8%，2020 年为 8.9%）。调整后，在研究期间使用肠外抗生素治疗的几率有所下降（调整后的比值比为 0.57；95% 置信区间为 0.41-0.80）。结论：在临床指南发布之前，莱姆脑膜炎儿童的肠外抗生素治疗已经在下降。需要精心设计的比较有效性研究来检查口服治疗方案与肠外治疗方案对临床结果的影响。
OBJECTIVES: Although ceftriaxone has been the first-line treatment of Lyme meningitis, the 2020 Infectious Disease Society of America, American College of Rheumatology, and American Academy of Neurology guideline recommends either doxycycline or ceftriaxone. Our objective was to explore recent trends in enteral antibiotic treatment of children with Lyme meningitis.METHODS: Using International Classification of Diseases, 10th Revision codes for case identification, we performed a multicenter retrospective study of patients ≤21 years of age presenting to a pediatric hospital contributing to the Pediatric Health Information System who were diagnosed with Lyme meningitis from 2015 to 2020. Our primary outcome was treatment with parenteral antibiotics, defined by either a procedure code for indwelling catheter placement or >7 days of inpatient parenteral Lyme disease-specific therapy. To examine trends over the study period, we used a generalized estimating equation, with parenteral antibiotics as the dependent variable and study year as the independent variable, adjusted for patient age, sex, race, ethnicity, and insurance status clustered by hospital.RESULTS: We identified 239 patients with Lyme meningitis treated at 24 participating centers. Overall, 48 (20.0%) were treated with parenteral antibiotics, with a declining rate over the study period (43.8% in 2015 to 8.9% in 2020). After adjustment, the odds of treatment with a parenteral antibiotic decreased over the study period (adjusted odds ratio 0.57; 95% confidence interval 0.41-0.80).CONCLUSIONS: Parenteral antibiotic treatment of children with Lyme meningitis has been on the decline in advance of the published clinical guideline. Carefully designed comparative effectiveness studies are needed to examine the effect of oral versus parenteral treatment regimens on clinical outcomes.