Divisions of Pulmonary Medicine Hospital, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Pediatr Pulmonol. 2020 Aug;55(8):2150-2155. doi: 10.1002/ppul.24884. Epub 2020 Jun 11.
Children who require chronic positive pressure ventilation (CPPV) are frequently hospitalized with acute respiratory infections. Although respiratory viral testing is often performed, it is unclear how positive results impact antibiotic use. We sought to assess the impact of respiratory viral testing on antibiotic use in hospitalized children on CPPV.
This retrospective cohort study included hospitalized children on CPPV who had respiratory viral polymerase chain reaction (RVP) testing on admission. Primary exposure was a positive RVP result; primary outcome was antibiotic de-escalation, defined as discontinuation of antibiotics or narrowing of antimicrobial spectra. To determine the independent association of positive RVP and antibiotic de-escalation, a generalized linear mixed effect model was used to account for within patient clustering and confounders defined a priori (blood and respiratory cultures, leukocytosis, bandemia, chest radiograph findings, aspiration risk, and recent admission).
A total of 200 admissions representing 118 patients were included. A viral pathogen was identified in 46.5% (93/200) of admissions; rhinovirus was most frequently identified (61.5% of positive RVPs). Antibiotic de-escalation occurred in 33% of admissions (35.5% of RVP-positive admissions vs 30.8% of RVP-negative admissions; P = .49). In adjusted analysis, there was no association between positive RVP and antibiotics de-escalation (adjusted OR: 0.86; 95% confidence interval: 0.32-2.26).
This single center cohort study suggests that respiratory viral testing may not impact antibiotic prescribing for hospitalized children on CPPV. There is need for improved stewardship of both diagnostic testing and antimicrobial use in this population.
需要慢性正压通气 (CPPV) 的儿童经常因急性呼吸道感染而住院。尽管经常进行呼吸道病毒检测，但阳性结果如何影响抗生素的使用尚不清楚。我们旨在评估呼吸道病毒检测对接受 CPPV 治疗的住院儿童抗生素使用的影响。
这项回顾性队列研究纳入了入院时接受呼吸道病毒聚合酶链反应 (RVP) 检测的接受 CPPV 治疗的住院儿童。主要暴露因素为 RVP 阳性结果；主要结局为抗生素降级，定义为停用抗生素或缩小抗菌谱。为了确定 RVP 阳性与抗生素降级的独立相关性，使用广义线性混合效应模型来解释患者内聚类，并预先定义混杂因素（血液和呼吸道培养物、白细胞增多、带状血症、胸部 X 光片发现、吸入风险和近期入院）。
共纳入 200 例住院，代表 118 例患者。93/200 例（46.5%）住院患儿确定了病毒病原体；最常鉴定出的病原体是鼻病毒（61.5%的 RVP 阳性）。33%的住院患儿（35.5%的 RVP 阳性住院患儿和 30.8%的 RVP 阴性住院患儿）进行了抗生素降级。在调整分析中，RVP 阳性与抗生素降级之间无关联（调整后的 OR：0.86；95%置信区间：0.32-2.26）。
这项单中心队列研究表明，呼吸道病毒检测可能不会影响接受 CPPV 治疗的住院儿童的抗生素处方。在该人群中，需要改进诊断检测和抗菌药物使用的管理。
