在接受阿莫西林治疗的社区获得性肺炎儿童前瞻性队列中，非典型细菌所致急性感染的演变情况。

Evolution of acute infection with atypical bacteria in a prospective cohort of children with community-acquired pneumonia receiving amoxicillin.

作者信息

Nascimento-Carvalho Cristiana M, Xavier-Souza Gabriel, Vilas-Boas Ana-Luisa, Fontoura Maria-Socorro H, Barral Aldina, Puolakkainen Mirja, Ruuskanen Olli

机构信息

Department of Paediatrics, Federal University of Bahia School of Medicine, Salvador, Brazil.

Department of Pathology, Federal University of Bahia School of Medicine and Centro de Pesquisa Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.

出版信息

J Antimicrob Chemother. 2017 Aug 1;72(8):2378-2384. doi: 10.1093/jac/dkx126.

DOI:10.1093/jac/dkx126

PMID:28475737

Abstract

BACKGROUND

Atypical bacteria are treatable causative agents of community-acquired pneumonia (CAP). However, there is no conclusive evidence that a child with CAP should receive empirical treatment against such agents.

OBJECTIVES

We assessed the possibility of association between clinical failure and acute infection by these bacteria among children with CAP treated with amoxicillin.

PATIENTS AND METHODS

Patients aged 2-59 months with non-severe CAP received amoxicillin during prospective follow-up. Acute and convalescent blood samples were collected. Probable acute infection by Mycoplasma pneumoniae (specific IgM antibodies), by Chlamydia pneumoniae or Chlamydia trachomatis (specific IgM antibodies and/or IgG/IgA titre change) was investigated. Outcomes were assessed during follow-up at 2, 5 and 14-28 days. Treatment failure included development of danger signs, persistent fever, tachypnoea or death. ClinicalTrials.gov: NCT01200706.

RESULTS

Of 787 children, 86 (10.9%; 95% CI = 8.9%-13.3%) had acute M. pneumoniae infection. C. pneumoniae acute infection was found in 79 of 733 (10.8%; 95% CI = 8.7%-13.2%) and C. trachomatis was found in 3 of 28 (10.7%; 95% CI = 2.8%-26.5%) <6 months old. Among patients with or without treatment failure at 2 days, acute M. pneumoniae infection (11.7% versus 10.7%; P = 0.7), acute C. pneumoniae infection (8.5% versus 11.3%; P = 0.3) and acute C. trachomatis infection (16.7% versus 9.1%; P = 0.5) were found. No significant differences were found with regard to treatment failure at the 5 day evaluation. Overall, amoxicillin was substituted in 3.5% versus 2.7% among patients with or without acute infection by one of these bacteria ( P = 0.6).

CONCLUSIONS

The overall substitution rate of amoxicillin was very low. It is not necessary to give an empirical non-β-lactam antibiotic as a first-line option to treat every child between 2 and 59 months old with non-severe CAP.

摘要

背景

非典型细菌是社区获得性肺炎（CAP）的可治疗病原体。然而，尚无确凿证据表明CAP患儿应接受针对此类病原体的经验性治疗。

目的

我们评估了接受阿莫西林治疗的CAP患儿临床治疗失败与这些细菌急性感染之间的关联可能性。

患者与方法

年龄在2至59个月的非重症CAP患者在前瞻性随访期间接受阿莫西林治疗。采集急性期和恢复期血样。调查肺炎支原体（特异性IgM抗体）、肺炎衣原体或沙眼衣原体（特异性IgM抗体和/或IgG/IgA滴度变化）可能的急性感染情况。在2、5和14至28天的随访期间评估治疗结果。治疗失败包括出现危险体征、持续发热、呼吸急促或死亡。ClinicalTrials.gov：NCT01200706。

结果

787名儿童中，86名（10.9%；95%置信区间=8.9%-13.3%）有肺炎支原体急性感染。在＜6个月的733名儿童中有79名（10.8%；95%置信区间=8.7%-13.2%）有肺炎衣原体急性感染，在28名＜6个月的儿童中有3名（10.7%；95%置信区间=2.8%-26.5%）有沙眼衣原体急性感染。在2天时治疗失败和未治疗失败的患者中，分别发现肺炎支原体急性感染（11.7%对10.7%；P = 0.7）、肺炎衣原体急性感染（8.5%对11.3%；P = 0.3）和沙眼衣原体急性感染（16.7%对9.1%；P = 0.5）。在5天评估时，治疗失败方面未发现显著差异。总体而言，感染其中一种细菌的急性感染患者和未感染患者中，阿莫西林的更换率分别为3.5%和2.7%（P = 0.6）。