Bundy David G, Richardson Troy E, Hall Matthew, Raphael Jean L, Brousseau David C, Arnold Staci D, Kalpatthi Ram V, Ellison Angela M, Oyeku Suzette O, Shah Samir S
Department of Pediatrics, Medical University of South Carolina, Charleston.
Department of Research and Statistics, Children's Hospital Association, Lenexa, Kansas.
JAMA Pediatr. 2017 Nov 1;171(11):1090-1099. doi: 10.1001/jamapediatrics.2017.2526.
Acute chest syndrome (ACS) is a common, serious complication of sickle cell disease (SCD) and a leading cause of hospitalization and death in both children and adults with SCD. Little is known about the effectiveness of guideline-recommended antibiotic regimens for the care of children hospitalized with ACS.
To use a large, national database to describe patterns of antibiotic use for children with SCD hospitalized for ACS and to determine whether receipt of guideline-adherent antibiotics was associated with lower readmission rates.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study including 14 480 hospitalizations in 7178 children (age 0-22 years) with a discharge diagnosis of SCD and either ACS or pneumonia. Information was obtained from 41 children's hospitals submitting data to the Pediatric Health Information System from January 1, 2010, to December 31, 2016.
National Heart, Lung, and Blood Institute guideline-adherent (macrolide with parenteral cephalosporin) vs non-guideline-adherent antibiotic regimens.
Acute chest syndrome-related and all-cause 7- and 30-day readmissions.
Of the 14 480 hospitalizations, 6562 (45.3%) were in girls; median (interquartile range) age was 9 (4-14) years. Guideline-adherent antibiotics were provided in 10 654 of 14 480 hospitalizations for ACS (73.6%). Hospitalizations were most likely to include guideline-adherent antibiotics for children aged 5 to 9 years (3230 of 4047 [79.8%]) and declined to the lowest level for children 19 to 22 years (697 of 1088 [64.1%]). Between-hospital variation in antibiotic regimens was wide, with use of guideline-adherent antibiotics ranging from 24% to 90%. Children treated with guideline-adherent antibiotics had lower 30-day ACS-related (odds ratio [OR], 0.71; 95% CI, 0.50-1.00) and all-cause (OR, 0.50; 95% CI, 0.39-0.64) readmission rates vs children who received other regimens (cephalosporin and macrolide vs neither drug class).
Current approaches to antibiotic treatment in children with ACS vary widely, but guideline-adherent therapy appears to result in fewer readmissions compared with non-guideline-adherent therapy. Efforts to increase the dissemination and implementation of SCD treatment guidelines are warranted as is comparative effectiveness research to strengthen the underlying evidence base.
急性胸综合征（ACS）是镰状细胞病（SCD）常见且严重的并发症，是SCD患儿和成人住院及死亡的主要原因。对于指南推荐的抗生素治疗方案用于治疗因ACS住院儿童的有效性，人们知之甚少。
利用一个大型全国性数据库来描述因ACS住院的SCD患儿的抗生素使用模式，并确定接受符合指南的抗生素治疗是否与较低的再入院率相关。
设计、设置和参与者：回顾性队列研究，纳入7178名0至22岁出院诊断为SCD且患有ACS或肺炎的儿童的14480次住院情况。信息来自2010年1月1日至2016年12月31日向儿科健康信息系统提交数据的41家儿童医院。
美国国立心肺血液研究所指南推荐的（大环内酯类联合胃肠外头孢菌素）与不符合指南的抗生素治疗方案。
与急性胸综合征相关的以及全因7天和30天再入院情况。
在14480次住院中，6562例（45.3%）为女孩；中位（四分位间距）年龄为9岁（4至14岁）。在14480例因ACS住院的病例中，10654例（73.6%）接受了符合指南的抗生素治疗。5至9岁儿童的住院治疗最有可能使用符合指南的抗生素（4047例中的3230例[79.8%]），而19至22岁儿童的使用比例降至最低水平（1088例中的697例[64.1%]）。各医院之间抗生素治疗方案的差异很大，符合指南的抗生素使用率在24%至90%之间。与接受其他治疗方案（头孢菌素和大环内酯类药物均未使用）的儿童相比，接受符合指南抗生素治疗的儿童30天内与急性胸综合征相关的再入院率较低（比值比[OR]，0.71；95%置信区间，0.50至1.00），全因再入院率也较低（OR，0.50；95%置信区间，0.39至0.64）。
目前针对ACS患儿的抗生素治疗方法差异很大，但与不符合指南的治疗相比，符合指南的治疗似乎能减少再入院情况。有必要努力加强SCD治疗指南的传播和实施，同时也需要开展比较有效性研究以加强基础证据基础。
