对于患有肺炎住院儿童的抗生素路线和结果
Jillian M Cotter1, Mathew Hall2, Mark I Neuman3,4
1Department of Pediatrics, Section of Hospital Medicine, Children's Hospital Colorado, University of Colorado, Aurora, Colorado, USA.
大多数患有社区获得性肺炎 (CAP) 的儿童可以用口服抗生素治疗,因为最初的静脉注射抗生素显示出类似的疗效. 虽然一些结果略有不同,但大多数结果是可比的,这表明口服抗生素通常适用于儿科CAP.
科学领域:
- 儿童传染病 儿童传染病
- 抗生素管理的管理.
- 医疗服务研究 医疗服务研究
背景情况:
- 新出现的证据表明,初始口服和静脉注射 (IV) 抗生素对儿科社区获得性肺炎 (CAP) 的疗效相似.
- 需要进一步的研究来证实这些发现,并了解抗生素处方在医院一级的变化.
研究的目的:
- 确定医院水平初始口服抗生素率与儿科CAP中的患者结果之间的关联.
- 为了比较住院时间,重症监护室 (ICU) 转移和初始口服抗生素使用率高低的医院之间的再入院等结果.
主要方法:
- 在43家医院 (2016-2022) 接受CAP治疗的30207名儿童的回顾性队列研究.
- 医院被分为高,中等或低口服抗生素利用组.
- 回归模型分析了医院口服抗生素率和结果之间的关联,包括停留时间 (LOS),ICU转移,升级呼吸护理,复杂的CAP,成本,再入院和急诊室 (ED) 再访.
主要成果:
- 最初的口服抗生素使用在各医院之间差异很大 (1%至68%),中位数为16%.
- 将高 (32%) 与低 (10%) 的口服医院进行比较,没有发现LOS,ICU转移,复杂的CAP,成本或ED重访的显著差异.
- 在高口服使用率的医院观察到更高的升级呼吸护理 (RR: 2.96) 和再入院 (RR: 1.68) 率,尽管这些事件很少发生,其临床意义尚不确定.
结论:
- 对于儿科CAP的初始口服抗生素使用率在医院水平上有很大的差异.
- 虽然罕见的不良事件,如升级呼吸系统护理和再入院,在高口服使用医院略高,但大多数关键结果与低口服使用医院相比相似.
- 大多数患有CAP的儿童可能会从口服抗生素中受益,但部分患者可能需要初始的静脉注射治疗.
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