临床决策规则对欧洲急诊科疑似下呼吸道感染患儿抗生素处方的影响：基于常规数据的模拟研究。
Impact of a clinical decision rule on antibiotic prescription for children with suspected lower respiratory tract infections presenting to European emergency departments: a simulation study based on routine data.
机构信息
Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
出版信息
J Antimicrob Chemother. 2021 Apr 13;76(5):1349-1357. doi: 10.1093/jac/dkab023.
BACKGROUND
Discriminating viral from bacterial lower respiratory tract infections (LRTIs) in children is challenging thus commonly resulting in antibiotic overuse. The Feverkidstool, a validated clinical decision rule including clinical symptoms and C-reactive protein, safely reduced antibiotic use in children at low/intermediate risk for bacterial LRTIs in a multicentre trial at emergency departments (EDs) in the Netherlands.
OBJECTIVES
Using routine data from an observational study, we simulated the impact of the Feverkidstool on antibiotic prescriptions compared with observed antibiotic prescriptions in children with suspected LRTIs at 12 EDs in eight European countries.
METHODS
We selected febrile children aged 1 month to 5 years with respiratory symptoms and excluded upper respiratory tract infections. Using the Feverkidstool, we calculated individual risks for bacterial LRTI retrospectively. We simulated antibiotic prescription rates under different scenarios: (1) applying effect estimates on antibiotic prescription from the trial; and (2) varying both usage (50%-100%) and compliance (70%-100%) with the Feverkidstool's advice to withhold antibiotics in children at low/intermediate risk for bacterial LRTI (≤10%).
RESULTS
Of 4938 children, 4209 (85.2%) were at low/intermediate risk for bacterial LRTI. Applying effect estimates from the trial, the Feverkidstool reduced antibiotic prescription from 33.5% to 24.1% [pooled risk difference: 9.4% (95% CI: 5.7%-13.1%)]. Simulating 50%-100% usage with 90% compliance resulted in risk differences ranging from 8.3% to 15.8%. Our simulations suggest that antibiotic prescriptions would be reduced in EDs with high baseline antibiotic prescription rates or predominantly (>85%) low/intermediate-risk children.
CONCLUSIONS
Implementation of the Feverkidstool could reduce antibiotic prescriptions in children with suspected LRTIs in European EDs.
背景
鉴别儿童病毒性和细菌性下呼吸道感染（LRTIs）具有挑战性，因此通常会导致抗生素过度使用。在荷兰的一项多中心试验中，Feverkidstool 是一种经过验证的临床决策规则，包括临床症状和 C 反应蛋白，它可以安全地减少低/中度细菌性 LRTIs 风险的儿童的抗生素使用。
目的
使用来自观察性研究的常规数据，我们模拟了 Feverkidstool 对在八个欧洲国家的 12 个急诊科疑似 LRTIs 儿童的抗生素处方的影响，与观察到的抗生素处方进行了比较。
方法
我们选择了年龄在 1 个月至 5 岁之间、有呼吸道症状且无上呼吸道感染的发热儿童。使用 Feverkidstool，我们回顾性计算了细菌性 LRTI 的个体风险。我们模拟了在不同情况下的抗生素处方率：（1）应用试验中抗生素处方的效果估计值；（2）在低/中度细菌性 LRTI（≤10%）风险儿童中，调整 Feverkidstool 建议不使用抗生素的使用率（50%-100%）和依从性（70%-100%）。
结果
在 4938 名儿童中，4209 名（85.2%）为低/中度细菌性 LRTI 风险。应用试验中的效果估计值，Feverkidstool 将抗生素处方从 33.5%减少到 24.1%[汇总风险差异：9.4%（95%CI：5.7%-13.1%）]。模拟 50%-100%的使用率和 90%的依从性，风险差异范围为 8.3%-15.8%。我们的模拟表明，在抗生素处方率较高或主要（>85%）为低/中度风险儿童的急诊科，抗生素处方会减少。
结论
在欧洲急诊科实施 Feverkidstool 可以减少疑似 LRTIs 儿童的抗生素处方。
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