住院儿童的抗生素相关不良事件。
Antibiotic-Associated Adverse Events in Hospitalized Children.
机构信息
Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
出版信息
J Pediatric Infect Dis Soc. 2021 May 28;10(5):622-628. doi: 10.1093/jpids/piaa173.
BACKGROUND
Antibiotic-associated adverse events (AEs) in hospitalized children have not been comprehensively characterized.
METHODS
We conducted a retrospective observational study of children hospitalized at The Johns Hopkins Hospital receiving ≥24 hours of systemic antibiotics. Consensus regarding antibiotic-associated AE definitions was established by 5 infectious diseases specialists prior to data collection. Two physicians reviewed potential AEs and determined whether they were more likely than not related to antibiotics after comprehensive manual chart review. Inpatient and post-discharge AEs were identified using the Epic Care Everywhere network. AEs evaluated from the initiation of antibiotics until 30 days after antibiotic completion included gastrointestinal, hematologic, hepatobiliary, renal, neurologic, dermatologic, cardiac, myositis, vascular access device-related events, and systemic reactions. Ninety-day AEs included Clostridioides difficile infections, multidrug-resistant organism infections, and clinically significant candidal infections. The impact of AEs was categorized as necessitating additional diagnostic testing, changes in medications, unplanned medical encounters, prolonged or new hospitalizations, or death.
RESULTS
Among 400 antibiotic courses, 21% were complicated by at least one AE and 30% occurred post-discharge. Each additional day of antibiotics was associated with a 7% increased odds of an AE. Of courses complicated by an AE, 66% required further intervention. Hematologic, gastrointestinal, and renal AEs were the most common, accounting for 31%, 15%, and 11% of AEs, respectively. AEs complicated 35%, 35%, 19%, and 18% of courses of piperacillin-tazobactam, tobramycin, ceftazidime, and vancomycin, respectively.
CONCLUSIONS
More than 1 in 5 courses of antibiotics administered to hospitalized children are complicated by AEs. Clinicians should weigh the risk of harm against expected benefit when prescribing antibiotics.
背景
抗生素相关不良事件（AE）在住院儿童中尚未得到全面描述。
方法
我们对在约翰霍普金斯医院住院接受≥24 小时全身抗生素治疗的儿童进行了回顾性观察性研究。在收集数据之前，5 名传染病专家就抗生素相关 AE 的定义达成了共识。两名医生审查了潜在的 AE，并在全面的手动图表审查后确定它们是否更有可能与抗生素相关。使用 Epic Care Everywhere 网络识别住院和出院后的 AE。从开始使用抗生素到抗生素完成后 30 天评估 AE，包括胃肠道、血液、肝胆、肾脏、神经、皮肤、心脏、肌炎、血管通路装置相关事件和全身性反应。90 天 AE 包括艰难梭菌感染、多药耐药菌感染和临床显著的念珠菌感染。AE 的影响分为需要额外的诊断测试、药物改变、非计划的医疗就诊、延长或新的住院治疗或死亡。
结果
在 400 个抗生素疗程中，21%至少发生了一次 AE，30%发生在出院后。抗生素使用天数每增加一天，AE 的发生几率增加 7%。在 AE 复杂化的课程中，66%需要进一步干预。血液、胃肠道和肾脏 AE 是最常见的，分别占 AE 的 31%、15%和 11%。AE 使哌拉西林-他唑巴坦、妥布霉素、头孢他啶和万古霉素的疗程复杂化的比例分别为 35%、35%、19%和 18%。
结论
在住院儿童中，超过 1/5 的抗生素疗程因 AE 而复杂化。当开具抗生素时，临床医生应权衡伤害风险与预期获益。
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