Department of Pediatrics and Communicable Diseases and
Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor, Michigan.
Pediatrics. 2018 Mar;141(3). doi: 10.1542/peds.2017-2182. Epub 2018 Feb 5.
Children with sickle cell anemia (SCA) are at increased risk for invasive pneumococcal disease; antibiotic prophylaxis significantly reduces this risk. We calculated the proportion of children with SCA who received ≥300 days of antibiotic prophylaxis and identified predictors of such receipt.
Children aged 3 months to 5 years with SCA were identified by the presence of 3 or more Medicaid claims with a diagnosis of SCA within a calendar year (2005-2012) in Florida, Illinois, Louisiana, Michigan, South Carolina, and Texas. Receipt of antibiotics was identified through claims for filled prescriptions. The outcome, receipt of ≥300 days of antibiotics, was assessed annually by using varying classifications of antibiotics. By using logistic regression with generalized estimating equations, we estimated the odds of receiving ≥300 days of antibiotics, with potential predictors of age, sex, year, state, and health services use.
A total of 2821 children contributed 5014 person-years. Overall, only 18% of children received ≥300 days of antibiotics. Each additional sickle cell disease-related outpatient visit (odds ratio = 1.01, 95% confidence interval: 1.01-1.02) and well-child visit (odds ratio = 1.08, 95% confidence interval: 1.02-1.13) was associated with incrementally increased odds of receiving ≥300 days of antibiotics.
Despite national recommendations and proven lifesaving benefit, antibiotic prophylaxis rates are low among children with SCA. Numerous health care encounters may offer an opportunity for intervention; in addition, such interventions likely need to include social factors that may affect the ability for a child to receive and adhere to antibiotic prophylaxis.
镰状细胞贫血（SCA）患儿罹患侵袭性肺炎球菌病的风险增加；抗生素预防可显著降低这种风险。我们计算了接受≥300 天抗生素预防的 SCA 患儿比例，并确定了接受这种预防的预测因素。
通过佛罗里达州、伊利诺伊州、路易斯安那州、密歇根州、南卡罗来纳州和德克萨斯州的医疗补助计划（Medicaid）中在一年内（2005-2012 年）有 3 次或以上镰状细胞贫血诊断的 3 个月至 5 岁患儿识别出 SCA 患儿。通过已填写处方的药物报销确定抗生素的使用。使用不同的抗生素分类，每年通过 logistic 回归与广义估计方程评估接受≥300 天抗生素的情况。通过 logistic 回归与广义估计方程，我们估计了接受≥300 天抗生素的可能性，同时考虑了年龄、性别、年份、州和卫生服务利用等潜在预测因素。
共有 2821 名儿童提供了 5014 人年的数据。总体而言，只有 18%的儿童接受了≥300 天的抗生素。每次额外的镰状细胞疾病相关门诊就诊（比值比=1.01，95%置信区间：1.01-1.02）和常规健康检查（比值比=1.08，95%置信区间：1.02-1.13）都与接受≥300 天抗生素的可能性呈递增关系。
尽管有国家推荐和已证明的挽救生命的益处，但 SCA 患儿的抗生素预防率仍然很低。许多卫生保健接触可能为干预提供机会；此外，此类干预措施可能需要包括影响儿童接受和坚持抗生素预防的社会因素。
