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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
1Gillings School of Public Health, University of North Carolina, Chapel Hill, NC, USA.
Pediatric nephrology (Berlin, Germany)
|January 20, 2024
概括
在患有膀回流 (VUR) 的儿童中,尿路感染 (UTIs) 的长期抗生素预防对于特定的亚组是最有益的,包括那些患有IV级VUR或肠膀功能障碍 (BBD) 的子组,显示需要治疗的数量较低.
科学领域:
- 儿科脏病学 儿科脏病学
- 传染性疾病 传染性疾病
- 临床试验分析
背景情况:
- 对患有尿道逆流症儿童的随机干预 (RIVUR) 试验表明,长期抗菌预防后,尿路感染的复发率减少了50%.
- 然而,所观察到的需要治疗的数量 (NNT) 是10,这表明需要确定受益更显著的子组.
研究的目的:
- 重新分析RIVUR试验数据,以确定患有膀外流 (VUR) 的儿童的特定亚组,这些儿童从长期抗微生物预防中获得更大的益处.
- 为预防性抗微生物药物使用,确定需要治疗 (NNT) 的次数较少的子组.
主要方法:
- 利用了来自RIVUR试验的患者级数据.
- 应用了惩罚性回归方法,将基线年龄,VUR等级,UTI指数类型和肠膀功能障碍 (BBD) 作为共同变量,以确定有益的子组.
主要成果:
- 确定了四个NNT为5或以下的子组:IV级VUR,BBD和发烧指数尿路感染的儿童 (1%);BBD和发烧指数尿路感染的儿童 (7%);BBD的儿童 (12%);和IV级VUR的儿童 (8%).
结论:
- 长期的抗微生物预防对于患有BBD (任何VUR等级) 和患有IV级VUR (无论BBD状态) 的儿童尤其重要.
- 需要进一步的研究来澄清预防性抗微生物药物在治疗BBD儿童的VUR中的作用,等待BBD更详细的治疗信息.
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