健康儿童血源性骨关节炎感染治疗期间抗生素诱发的中性粒细胞减少症

Antibiotic-Induced Neutropenia During Treatment of Hematogenous Osteoarticular Infections in Otherwise Healthy Children.

作者信息

Solis Krystian, Dehority Walter

出版信息

J Pediatr Pharmacol Ther. 2019 Sep-Oct;24(5):431-437. doi: 10.5863/1551-6776-24.5.431.

DOI:10.5863/1551-6776-24.5.431

PMID:31598107

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6782118/

Abstract

OBJECTIVES

We studied the frequency and characteristics of antibiotic-induced neutropenia in otherwise healthy children receiving antibiotic therapy for hematogenous osteoarticular infections (OAIs).

METHODS

We retrospectively enrolled otherwise healthy children between 1 month and 18 years of age discharged with an OAI from our institution over an 11-year period. An absolute neutrophil count (ANC) ≤1500 cells/μL was defined as neutropenia. We recorded demographic and clinical information, as well as the value and timing of each ANC in relation to changes in antibiotic therapy. A multivariable regression model assessed the contributions of various risk factors.

RESULTS

A total of 186 children were enrolled (mean age, 7.6 years; 67.2% boys). β-Lactams represented 61.2% of all prescriptions. During treatment, 61 subjects (32.8%) developed neutropenia (median time to onset, 24 days). An ANC < 500 cells/μL occurred in 7 subjects (3.8%). Neutropenic subjects (mean age, 6.0 years) were significantly younger than those without neutropenia (mean age, 8.5 years) (OR = 0.86; 95% CI: 0.79-0.93; p < 0.001) and received significantly longer courses of total (89.3 vs. 55.8 days) and parenteral (24.6 vs. 19.9 days) antibiotic therapy (OR = 1.01; 95% CI: 1.01-1.02; p = 0.004 and OR = 1.02; 95% CI: 1.01-1.04; p = 0.041, respectively). Recurrent neutropenia occurred in 23.0% of all neutropenic subjects and was significantly more common in those with a longer mean duration of parenteral therapy (OR = 1.05; 95% CI: 1.02-1.09; p = 0.004.). No complications from neutropenia occurred.

CONCLUSIONS

Neutropenia was common in our cohort of children receiving prolonged antibiotic therapy for OAIs. Younger age and longer courses of therapy were associated with an increased risk of neutropenia.

摘要

目的

我们研究了在因血源性骨关节炎感染（OAIs）接受抗生素治疗的健康儿童中，抗生素诱导的中性粒细胞减少症的发生率及特征。

方法

我们回顾性纳入了11年间从我们机构出院的1至18岁因OAIs感染的健康儿童。绝对中性粒细胞计数（ANC）≤1500个细胞/μL被定义为中性粒细胞减少症。我们记录了人口统计学和临床信息，以及每次ANC的值和时间与抗生素治疗变化的关系。多变量回归模型评估了各种危险因素的作用。

结果

共纳入186名儿童（平均年龄7.6岁；67.2%为男孩）。β-内酰胺类药物占所有处方的61.2%。治疗期间，61名受试者（32.8%）出现中性粒细胞减少症（中位发病时间为24天）。7名受试者（3.8%）的ANC<500个细胞/μL。中性粒细胞减少症受试者（平均年龄6.0岁）明显比无中性粒细胞减少症的受试者年轻（平均年龄8.5岁）（OR=0.86；95%CI：0.79-0.93；p<0.001），并且接受的总抗生素治疗疗程（89.3天对55.8天）和肠外抗生素治疗疗程（24.6天对19.9天）明显更长（OR分别为1.01；95%CI：1.01-1.02；p=0.004和OR=1.02；95%CI：1.01-1.04；p=0.041）。所有中性粒细胞减少症受试者中有23.0%出现复发性中性粒细胞减少症，在肠外治疗平均持续时间较长的患者中更常见（OR=1.05；95%CI：1.02-1.09；p=0.004）。未发生中性粒细胞减少症的并发症。