목적: 상기도 감염인 소아에게 항생제를 처방하는 것은 아직도 많은 진료실에서 이루어지고 있다. 이 연구는 역전사중합효소연쇄반응 검사로 호흡기 바이러스가 확인된 이후에도 항생제를 사용한 소아 환자들의 임상적 특징을 조사하고자 하였다. 방법: 2013년 1월부터 2014년 11월에 고신대학교 복음병원 소아청소년과에 상기도 감염으로 입원한 환자 중 역전사 중합효소연쇄반응을 시행한 환자들을 대상으로 후향적 의무기록 분석을 통해 평가하였다. 결과: 상기도 감염으로 진단받은 393명 중 전체 환자 연령의 중앙값은 23개월이었다. 입원 당시 항생제를 처방받은 환자(79명, 20.1%)와 항생제를 처방받지 않은 환자들의 임상적 요인을 비교할 때, 중이염 또는 부비동염의 동반, 높은 고감도 C-반응단백질의 수치가 항생제 처방과 의미 있게 관련 있었다(P<0.001). 입원하여 항생제를 사용하던 중 역전사 중합효소연쇄반응 방법으로 호흡기 바이러스가 확인되었지만, 항생제를 계속 사용한 환자는 44명 중 28명(63.6%)이었다. 항생제를 계속 사용한 환자는 항생제를 중단한 환자와 비교할 때 중이염 동반 비율이 유의하게 높았다(75% vs. 25%, P=0.002). 결론: 본 연구에서 상기도 감염의 원인이 바이러스임을 확인된 소아 환자에게서도 항생제를 지속한 주된 이유는 중이염이 동반되었기 때문이었다. 중이염을 정확하게 진단하고 그 중 항생제가 꼭 필요한 경우를 가려낸다면 소아 상기도 감염에서 불필요한 항생제 사용을 줄이는 데 도움이 될 것으로 생각된다.
목적: 상기도 감염인 소아에게 항생제를 처방하는 것은 아직도 많은 진료실에서 이루어지고 있다. 이 연구는 역전사 중합효소연쇄반응 검사로 호흡기 바이러스가 확인된 이후에도 항생제를 사용한 소아 환자들의 임상적 특징을 조사하고자 하였다. 방법: 2013년 1월부터 2014년 11월에 고신대학교 복음병원 소아청소년과에 상기도 감염으로 입원한 환자 중 역전사 중합효소연쇄반응을 시행한 환자들을 대상으로 후향적 의무기록 분석을 통해 평가하였다. 결과: 상기도 감염으로 진단받은 393명 중 전체 환자 연령의 중앙값은 23개월이었다. 입원 당시 항생제를 처방받은 환자(79명, 20.1%)와 항생제를 처방받지 않은 환자들의 임상적 요인을 비교할 때, 중이염 또는 부비동염의 동반, 높은 고감도 C-반응단백질의 수치가 항생제 처방과 의미 있게 관련 있었다(P<0.001). 입원하여 항생제를 사용하던 중 역전사 중합효소연쇄반응 방법으로 호흡기 바이러스가 확인되었지만, 항생제를 계속 사용한 환자는 44명 중 28명(63.6%)이었다. 항생제를 계속 사용한 환자는 항생제를 중단한 환자와 비교할 때 중이염 동반 비율이 유의하게 높았다(75% vs. 25%, P=0.002). 결론: 본 연구에서 상기도 감염의 원인이 바이러스임을 확인된 소아 환자에게서도 항생제를 지속한 주된 이유는 중이염이 동반되었기 때문이었다. 중이염을 정확하게 진단하고 그 중 항생제가 꼭 필요한 경우를 가려낸다면 소아 상기도 감염에서 불필요한 항생제 사용을 줄이는 데 도움이 될 것으로 생각된다.
Purpose: The inappropriate prescription of antibiotics in children with upper respiratory tract infection (URTI) is common. This study evaluated the factors that influence antibiotics use in hospitalized children with viral URTI confirmed by reverse transcriptase-polymerase chain reaction (RTPCR) as...
Purpose: The inappropriate prescription of antibiotics in children with upper respiratory tract infection (URTI) is common. This study evaluated the factors that influence antibiotics use in hospitalized children with viral URTI confirmed by reverse transcriptase-polymerase chain reaction (RTPCR) assay. Methods: The medical records of admitted patients who performed RT-PCR assay for respiratory virus pathogens from January 2013 to November 2014 were examined. The demographic and clinical features were compared between patients who were administered antibiotics at admission and those who were not. We also investigated differences between children who continued antibiotics and those who stopped antibiotics after a viral pathogen was identified. Results: In the total 393 inpatients, the median age was 23 months (interquartile range, 13 to 41.3 months). Antimicrobial agents were prescribed in 79 patients (20.1%) at admission. Patients with acute otitis media (AOM) had higher rates of antibiotics prescription than those without AOM (48.1% vs. 2.2%, P<0.001), with an adjusted odds ratio of 91.1 (95% confidence interval, 30.5 to 271.7). Level of high-sensitivity C-reactive protein and the proportion of acute rhinosinusitis were also significantly associated with antibiotics use (P<0.001). Among the 44 patients with viruses identified using the RT-PCR method during hospitalization, antibiotic use was continued in 28 patients (63.6%). AOM was statistically associated with continued antibiotic use in the patients (P=0.002). Conclusions: Although the respiratory virus responsible for URTI etiology is identified, clinicians might not discontinue antibiotics if AOM is accompanying. Therefore, careful diagnosis and management of AOM could be a strategy to reduce unjustified antibiotic prescriptions for children with URTI.
Purpose: The inappropriate prescription of antibiotics in children with upper respiratory tract infection (URTI) is common. This study evaluated the factors that influence antibiotics use in hospitalized children with viral URTI confirmed by reverse transcriptase-polymerase chain reaction (RTPCR) assay. Methods: The medical records of admitted patients who performed RT-PCR assay for respiratory virus pathogens from January 2013 to November 2014 were examined. The demographic and clinical features were compared between patients who were administered antibiotics at admission and those who were not. We also investigated differences between children who continued antibiotics and those who stopped antibiotics after a viral pathogen was identified. Results: In the total 393 inpatients, the median age was 23 months (interquartile range, 13 to 41.3 months). Antimicrobial agents were prescribed in 79 patients (20.1%) at admission. Patients with acute otitis media (AOM) had higher rates of antibiotics prescription than those without AOM (48.1% vs. 2.2%, P<0.001), with an adjusted odds ratio of 91.1 (95% confidence interval, 30.5 to 271.7). Level of high-sensitivity C-reactive protein and the proportion of acute rhinosinusitis were also significantly associated with antibiotics use (P<0.001). Among the 44 patients with viruses identified using the RT-PCR method during hospitalization, antibiotic use was continued in 28 patients (63.6%). AOM was statistically associated with continued antibiotic use in the patients (P=0.002). Conclusions: Although the respiratory virus responsible for URTI etiology is identified, clinicians might not discontinue antibiotics if AOM is accompanying. Therefore, careful diagnosis and management of AOM could be a strategy to reduce unjustified antibiotic prescriptions for children with URTI.
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문제 정의
This study was conducted to evaluate the factors associated with antibiotic use in children hospitalized with URTI and to identify the clinical characteristics associated with continued use of prescription antibiotics notwithstanding the detection of a respiratory virus by RT-PCR.
가설 설정
Our study has several limitations. First, the diagnosis of AOM was not made precisely. The results were not deduced based on an exact diagnosis protocol but electronic medical records.
제안 방법
05 was considered to indicate statistical significance. All variables that were significant in the previous test were evaluated with the use multivariable logistic-regression models to analyze factors associated with initial antibiotics prescription.
Demographic characteristics and clinical and laboratory information were obtained from electrical medical records. Clinical information included the diagnoses made by pediatrician at admission and discharge, complications, duration of hospital stay, fever duration, whether antibiotics were used before and after the respiratory virus results being reported, and antibiotic classification. Complications of URTI at admission were classified as either acute otitis media (AOM) or acute rhinosinusitis.
Data were collected by reviewing the electronic medical records of all cases of admitted children <18 years of age, on whom multiplex RT-PCR using the Seeplex RV7 Detection System (Seegene Inc., Seoul, Korea) were performed between January 2013 and November 2014.
In a recent study that compared viral PCR results from children with respiratory infection to asymptomatic matched controls, respiratory viruses, such as bocavirus, rhinovirus, adenovirus, coronavirus, and enterovirus, were frequently detected in asymptomatic matched controls29). Fourth, this trial was not performed for all inpatients who were diagnosed with an upper respiratory virus but was limited to subjects who received viral RT-PCR analysis. In addition, the performance of our study in a tertiary care center, where antibiotic use is less likely than in a primary care setting, limits the ability to extend our results to a general pediatric clinic.
In this study, we analyzed the factors related to use antibiotics in patients with URTI. Children who were administered antibiotics at admission had a higher prevalence of AOM compared with those who did not.
The results were not deduced based on an exact diagnosis protocol but electronic medical records. Second, the RT-PCR analyses in our study were performed only twice a week, resulting in discharged patients before PCR results was reported. This fact could have decreased the advantage provided by RT-PCR as a rapid diagnostic tool, which could have an effect on antibiotic prescription rates.
대상 데이터
Antibiotics were prescribed for 79 patients (20.1%) with URTI upon admission. The demographic and clinical characteristics of the patients who received antibiotics were compared with those of the 314 patients (79.
During the study period, RT-PCR assays were performed on a total of 1,277 patients upon admission. Of these, 393 inpatients met the inclusion criteria.
Respiratory viruses were detected using the RT-PCR test in 223 (56.7%) of 393 patients. Of these, 43 patients (19.
Seven viruses (influenza viruses A and B, respiratory syncytial virus, adenovirus, parainfluenza virus, rhinovirus, and human metapneumovirus) were included in the panel.
The medical records of the Department of Pediatrics, Kosin University Gospel Hospital (Busan, Korea), a tertiary care center, were analyzed. Data were collected by reviewing the electronic medical records of all cases of admitted children <18 years of age, on whom multiplex RT-PCR using the Seeplex RV7 Detection System (Seegene Inc.
데이터처리
*P-values are for comparisons across groups, with the use of Fisher exact test or chi-square test for categorical variables and the Mann-Whitney U test for continuous variables.
Categorical variables were compared using the chi-square test or Fisher exact test to determine the relationships between antibiotic prescriptions and clinically informed variables. The Student t-test was used to compare continuous variables, and data without a normal distribution were analyzed with the Mann-Whitney U test. P-value less than 0.
이론/모형
, Armonk, NY, USA). Categorical variables were compared using the chi-square test or Fisher exact test to determine the relationships between antibiotic prescriptions and clinically informed variables. The Student t-test was used to compare continuous variables, and data without a normal distribution were analyzed with the Mann-Whitney U test.
성능/효과
However, other studies have revealed that rapid communication of RT-PCR results did not reduce antibiotic use28). Third, it is unlikely that positive RT-PCR results always imply a true viral respiratory tract infection. In a recent study that compared viral PCR results from children with respiratory infection to asymptomatic matched controls, respiratory viruses, such as bocavirus, rhinovirus, adenovirus, coronavirus, and enterovirus, were frequently detected in asymptomatic matched controls29).
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