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膀管外流的抗菌预防:哪些子组的儿童受益最多?
Beibo Zhao1, Anastasia Ivanova1, Nader Shaikh2
1The University of North Carolina at Chapel Hill Gillings School of Global Public Health.
Research square
|September 11, 2023
概括
长期抗生素预防的好处是选择患有膀外逆流 (VUR) 的儿童. 对RIVUR试验的子组分析发现,患有肠膀功能障碍 (BBD) 或高度VUR的儿童需要治疗以预防尿路感染的数量较低.
科学领域:
- 儿科脏病学 儿科脏病学
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 传染性疾病 传染性疾病
背景情况:
- 随机干预试验 (RIVUR) 显示,抗微生物预防可以将尿路感染的复发减少50%.
- 然而,治疗所需的总人数 (NNT) 为10,表明需要确定更受益的特定患者子组.
- 膀回流 (VESICOURETERAL REFLUX,简称VUR) 是一种尿液从膀逆向流向脏的情况,增加了尿路感染的风险.
研究的目的:
- 重新分析RIVUR试验数据,以确定患有VUR的儿童子组,从长期抗菌预防中获得更大的益处.
- 确定需要治疗 (NNT) 治疗次数较少的子组,以预防尿路感染复发.
主要方法:
- 来自RIVUR试验的患者级数据使用惩罚回归方法进行了分析.
- 共同变量包括基线年龄,VUR等级和肠膀功能障碍 (BBD).
- 分析的重点是确定分组,以平衡绝对风险差异和样本大小.
主要成果:
- 确定了三个小组,NNT小于10的小组.
- 患有IV级VUR和BBD的儿童 (1%的样本) 的NNT为2.
- 患有BBD的儿童 (12%的样本) 的NNT为4,患有BBD和任何等级VUR或等级IVVUR的儿童 (19%的样本) 的NNT为4.
结论:
- 长期的抗微生物预防对于患有VUR和BBD或高度VUR的儿童尤其有益.
- 这些特定的子组经历了更有利的需要治疗的数量,以预防复发性尿路感染.
- 有针对性的预防策略可以优化儿科VUR管理中的治疗疗效.
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